Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center

Autor(es):Mostrar menos -

Thomaz, Danilo Y. ^[1] ; de Almeida, Joao N. ^{[2, 1, 3]} ; Sejas, Odeli N. E. ^[4] ; Del Negro, Gilda M. B. ^[1] ; Carvalho, Gabrielle O. M. H. ^[1] ; Gimenes, Viviane M. F. ^[1] ; de Souza, Maria Emilia B. ^[4] ; Arastehfar, Amir ^[2] ; Camargo, Carlos H. ^[5] ; Motta, Adriana L. ^[3] ; Rossi, Flavia ^[3] ; Perlin, David S. ^[2] ; Freire, Maristela P. ^[4] ; Abdala, Edson ^[4] ; Benard, Gil ^[1]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Fac Med, Lab Med Mycol LIM 53, Inst Med Trop, Hosp Clin, BR-05403000 Sao Paulo - Brazil

^[2] Hackensack Meridian Hlth, Ctr Discovery & Innovat, Nutley, NJ 07110 - USA

^[3] Univ Sao Paulo, Fac Med, Hosp Clin, Cent Lab Div LIM 03, BR-05403010 Sao Paulo - Brazil

^[4] Univ Sao Paulo, Canc Inst Sao Paulo State, Hosp Clin, Fac Med, BR-01246000 Sao Paulo - Brazil

^[5] Adolfo Lutz Inst, Bacteriol Ctr, BR-01246000 Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: JOURNAL OF FUNGI; v. 7, n. 4 APR 2021.
• Citações Web of Science: 1

Resumo

Clonal outbreaks due to azole-resistant Candida parapsilosis (ARCP) isolates have been reported in numerous studies, but the environmental niche of such isolates has yet to be defined. Herein, we aimed to identify the environmental niche of ARCP isolates causing unremitting clonal outbreaks in an adult ICU from a Brazilian cancer referral center. C. parapsilosis sensu stricto isolates recovered from blood cultures, pericatheter skins, healthcare workers (HCW), and nosocomial surfaces were genotyped by multilocus microsatellite typing (MLMT). Antifungal susceptibility testing was performed by the EUCAST (European Committee for Antimicrobial Susceptibility Testing) broth microdilution reference method and ERG11 was sequenced to determine the azole resistance mechanism. Approximately 68% of isolates were fluconazole-resistant (76/112), including pericatheter skins (3/3, 100%), blood cultures (63/70, 90%), nosocomial surfaces (6/11, 54.5%), and HCW's hands (4/28, 14.2%). MLMT revealed five clusters: the major cluster contained 88.2% of ARCP isolates (67/76) collected from blood (57/70), bed (2/2), pericatheter skin (2/3), from carts (3/7), and HCW's hands (3/27). ARCP isolates were associated with a higher 30 day crude mortality rate (63.8%) than non-ARCP ones (20%, p = 0.008), and resisted two environmental decontamination attempts using quaternary ammonium. This study for the first time identified ARCP isolates harboring the Erg11-Y132F mutation from nosocomial surfaces and HCW's hands, which were genetically identical to ARCP blood isolates. Therefore, it is likely that persisting clonal outbreak due to ARCP isolates was fueled by environmental sources. The resistance of Y132F ARCP isolates to disinfectants, and their potential association with a high mortality rate, warrant vigilant source control using effective environmental decontamination. (AU)

• Processo FAPESP: 19/17851-0 - Genotipagem por análise de microssatélites de isolados de Candida parapsilosis (sensu stricto) obtidos de casos de Candidíase Invasiva
• Beneficiário: Gabrielle Oliveira Marques Haddad Carvalho
• Modalidade de apoio: Bolsas no Brasil - Iniciação Científica
• Processo FAPESP: 17/00231-3 - Diagnóstico precoce de candidemia em pacientes críticos: análise comparativa entre os métodos de PCR em tempo real, MALDI-TOF e detecção de 1,3-beta-D-glucana
• Beneficiário: Gilda Maria Barbaro Del Negro
• Modalidade de apoio: Auxílio à Pesquisa - Regular
• Processo FAPESP: 18/19347-4 - Caracterização de mecanismos moleculares associados à resistência aos derivados azólicos em cepas clínicas de Trichosporon asahii
• Beneficiário: João Nóbrega de Almeida Júnior
• Modalidade de apoio: Bolsas no Exterior - Pesquisa
• Processo FAPESP: 16/08730-6 - Patogenicidade fúngica: efeito do tabagismo, resposta imune e a modulação vacinal na paracoccidioidomicose e na histoplasmose
• Beneficiário: Carlos Pelleschi Taborda
• Modalidade de apoio: Auxílio à Pesquisa - Temático