Changing epidemiology of candidaemia: Increase in fluconazole‐resistant Candida parapsilosis

• DOI: 10.1111/myc.13050
• Publication Date: 2020-01-18T19:05:00Z
• Authors: Alessio Mesini; Małgorzata Mikulska; Daniele Roberto G...; Filippo Del Puente; Nemo Gandolfo; Giulia Codda; Andrea Orsi; Federico Tassinari; Sabrina Beltramini; Anna Marchese; Giancarlo Icardi; Valerio Del Bono; Claudio Viscoli
• Keywords: Aged, 80 and over; Male; 0301 basic medicine; Antifungal Agents; Candida parapsilosis; antifungal resistance; Candida parapsilosis predictors; cluster; echinocandins exposure; Aged; Aged, 80 and over; Antifungal Agents; Candidemia; Female; Fluconazole; Humans; Incidence; Male; Middle Aged; Prospective Studies; Random Amplified Polymorphic DNA Technique; Retrospective Studies; Candida parapsilosis; Drug Resistance, Fungal; Incidence; Candidemia; Middle Aged; Random Amplified Polymorphic DNA Technique; 03 medical and health sciences; Drug Resistance, Fungal; Humans; Female; Prospective Studies; Fluconazole; Aged; Retrospective Studies

SummaryAimDuring the last decade a continuous increase in non‐albicans species isolation has been observed with Candida parapsilosis being one of the leading species. Aim of this study was to describe the epidemiology of candidemia, particularly of C parapsilosis, its predictors and clinical outcome.Materials and MethodsIncidences of candidemia was evaluated analyzing data from both a prospective collection (2012‐2016) and a retrospective one (2008‐2011). Predictors and outcome were based only on the prospective phase. C parapsilosis potential clusters were analysed by randomly amplified polymorphic DNA (RAPD) technique.Results1240 episodes were identified. Incidences of candidemia increased from 1.97 episodes/10 000 patient‐days in 2008 to 4.59/10 000 patient‐days in 2016 (P < .001), mainly due to an increase of C parapsilosis (incidence rate ratio, IRR: 1.04, P < .001). 33.0% of C parapsilosis strains were resistant to fluconazole; no resistance to echinocandins was found. Independent predictors of C parapsilosis candidemia were time of infection (P = .007), previous use of echinocandins (P < .0001) and year in which the episode was registered (P < .0001). 30 days mortality was 32.4% for C parapsilosis, with a significant difference compared to C non‐parapsilosis. Potential clonal C parapsilosis strains were detected by genetic analyses, showing RAPD profile A as the most represented (72.6% of isolates).DiscussionC parapsilosis candidemia is an emerging issue in our center, possibly attributed to some extent to horizontal transmission of the pathogen, as confirmed by the analysis of isolates similarities. Further microbiological and epidemiological investigations are needed in order to identify the most effective measures to reduce the rate of this infection.