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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
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 ad...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066986/ https://www.ncbi.nlm.nih.gov/pubmed/33808442 http://dx.doi.org/10.3390/jof7040259 |
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author | Thomaz, Danilo Y. de Almeida, João N. Sejas, Odeli N. E. Del Negro, Gilda M. B. Carvalho, Gabrielle O. M. H. Gimenes, Viviane M. F. de Souza, Maria Emilia B. Arastehfar, Amir Camargo, Carlos H. Motta, Adriana L. Rossi, Flávia Perlin, David S. Freire, Maristela P. Abdala, Edson Benard, Gil |
author_facet | Thomaz, Danilo Y. de Almeida, João N. Sejas, Odeli N. E. Del Negro, Gilda M. B. Carvalho, Gabrielle O. M. H. Gimenes, Viviane M. F. de Souza, Maria Emilia B. Arastehfar, Amir Camargo, Carlos H. Motta, Adriana L. Rossi, Flávia Perlin, David S. Freire, Maristela P. Abdala, Edson Benard, Gil |
author_sort | Thomaz, Danilo Y. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8066986 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-80669862021-04-25 Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center Thomaz, Danilo Y. de Almeida, João N. Sejas, Odeli N. E. Del Negro, Gilda M. B. Carvalho, Gabrielle O. M. H. Gimenes, Viviane M. F. de Souza, Maria Emilia B. Arastehfar, Amir Camargo, Carlos H. Motta, Adriana L. Rossi, Flávia Perlin, David S. Freire, Maristela P. Abdala, Edson Benard, Gil J Fungi (Basel) Article 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. MDPI 2021-03-30 /pmc/articles/PMC8066986/ /pubmed/33808442 http://dx.doi.org/10.3390/jof7040259 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Thomaz, Danilo Y. de Almeida, João N. Sejas, Odeli N. E. Del Negro, Gilda M. B. Carvalho, Gabrielle O. M. H. Gimenes, Viviane M. F. de Souza, Maria Emilia B. Arastehfar, Amir Camargo, Carlos H. Motta, Adriana L. Rossi, Flávia Perlin, David S. Freire, Maristela P. Abdala, Edson Benard, Gil Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center |
title | Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center |
title_full | Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center |
title_fullStr | Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center |
title_full_unstemmed | Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center |
title_short | Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center |
title_sort | environmental clonal spread of azole-resistant candida parapsilosis with erg11-y132f mutation causing a large candidemia outbreak in a brazilian cancer referral center |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066986/ https://www.ncbi.nlm.nih.gov/pubmed/33808442 http://dx.doi.org/10.3390/jof7040259 |
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