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

Laboratory of Medical Mycology (LIM-53), Instituto de Medicina Tropical e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil

Central Laboratory Division (LIM-03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil

Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA

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Cancer Institute of São Paulo State, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil

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Bacteriology Center, Instituto Adolfo Lutz, São Paulo 01246-000, Brazil

Authors to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

^‡

These senior authors contributed equally to this work.

Academic Editor: Juliana Campos Junqueira

J. Fungi 2021, 7(4), 259; https://doi.org/10.3390/jof7040259

Received: 10 February 2021 / Revised: 17 March 2021 / Accepted: 25 March 2021 / Published: 30 March 2021

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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Abstract

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. View Full-Text

Keywords: clonal outbreak; candidemia; Candida parapsilosis; antifungal agents; azole-resistant; drug resistance mechanisms; ERG11 mutations; microsatellite typing; environmental reservoirs; horizontal transmission

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MDPI and ACS Style

Thomaz, D.Y.; de Almeida, J.N., Jr.; Sejas, O.N.E.; Del Negro, G.M.B.; Carvalho, G.O.M.H.; Gimenes, V.M.F.; de Souza, M.E.B.; Arastehfar, A.; Camargo, C.H.; Motta, A.L.; Rossi, F.; Perlin, D.S.; Freire, M.P.; Abdala, E.; Benard, G. Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center. J. Fungi 2021, 7, 259. https://doi.org/10.3390/jof7040259

AMA Style

Thomaz DY, de Almeida JN Jr., Sejas ONE, Del Negro GMB, Carvalho GOMH, Gimenes VMF, de Souza MEB, Arastehfar A, Camargo CH, Motta AL, Rossi F, Perlin DS, Freire MP, Abdala E, Benard G. Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center. Journal of Fungi. 2021; 7(4):259. https://doi.org/10.3390/jof7040259

Chicago/Turabian Style

Thomaz, Danilo Y., João N. de Almeida Jr., Odeli N.E. Sejas, Gilda M.B. Del Negro, Gabrielle O.M.H. Carvalho, Viviane M.F. Gimenes, Maria E.B. de Souza, Amir Arastehfar, Carlos H. Camargo, Adriana L. Motta, Flávia Rossi, David S. Perlin, Maristela P. Freire, Edson Abdala, and Gil Benard. 2021. "Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center" Journal of Fungi 7, no. 4: 259. https://doi.org/10.3390/jof7040259

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

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