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Changing epidemiology of candidaemia: Increase in fluconazole‐resistant Candida parapsilosis
Author(s) -
Mesini Alessio,
Mikulska Małgorzata,
Giacobbe Daniele Roberto,
Del Puente Filippo,
Gandolfo Nemo,
Codda Giulia,
Orsi Andrea,
Tassinari Federico,
Beltramini Sabrina,
Marchese Anna,
Icardi Giancarlo,
Del Bono Valerio,
Viscoli Claudio
Publication year - 2020
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/myc.13050
Subject(s) - candida parapsilosis , fluconazole , incidence (geometry) , biology , microbiology and biotechnology , medicine , corpus albicans , epidemiology , antifungal , physics , optics
Summary Aim During 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 Methods Incidences 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. Results 1240 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). Discussion C 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.