Prospective Multicenter Study of the Epidemiology, Molecular Identification, and Antifungal Susceptibility of Candida parapsilosis, Candida orthopsilosis, and Candida metapsilosis Isolated from Patients with Candidemia


Por: Canton, E, Peman, J, Quindos, G, Eraso, E, Miranda-Zapico, I, Alvarez, M, Merino, P, Campos-Herrero, I, Marco, F, de la Pedrosa, EGG, Yaguue, G, Guna, R, Rubio, C, Miranda, C, Pazos, C, Velasco, D, Sánchez-Reus F., FUNGEMYCA Study Grp

Publicada: 1 dic 2011
Resumen:
A 13-month prospective multicenter study including 44 hospitals was carried out to evaluate the epidemiology of Candida parapsilosis complex candidemia in Spain. Susceptibility to amphotericin B, flucytosine, fluconazole, itraconazole, voriconazole, posaconazole, anidulafungin, caspofungin, and micafungin was tested by the microdilution colorimetric method. A total of 364 C. parapsilosis complex isolates were identified by molecular methods: C. parapsilosis (90.7%), Candida orthopsilosis (8.2%), and Candida metapsilosis (1.1%). Most candidemias (C. parapsilosis, 76.4%; C. orthopsilosis, 70.0%; C. metapsilosis, 100%) were observed in adults. No C. orthopsilosis or C. metapsilosis candidemias occurred in neonates. C. parapsilosis was most frequent in adult intensive care unit (28.8%), surgery (20.9%), and internal medicine (19.7%) departments; and C. orthopsilosis was most frequent in hematology (28.6%), pediatrics (12.0%), and neonatology (11.5%) departments. The geographic distribution of C. orthopsilosis and C. metapsilosis was not uniform. According to CLSI clinical breakpoints, all C. orthopsilosis and C. metapsilosis isolates were susceptible to the nine agents tested. Resistance (MICs > 1 mg/liter) was observed only in C. parapsilosis: amphotericin B, posaconazole, itraconazole, and caspofungin (0.3% each), anidulafungin (1.9%), and micafungin (2.5%). Applying the new species-specific fluconazole and echinocandin breakpoints, the rates of resistance to fluconazole for C. parapsilosis and C. orthopsilosis increased to 4.8% and 0.3%, respectively; conversely, for C. parapsilosis they shifted from 1.9 to 0.6% (anidulafungin) and from 2.5 to 0.6% (micafungin). Our study confirms the different prevalence of C. parapsilosis complex candidemia among age groups: neither C. orthopsilosis nor C. metapsilosis was isolated from neonates; interestingly, C. metapsilosis was isolated only from adults and the elderly. The disparity in antifungal susceptibility among species could be important for therapy.

Filiaciones:
Canton, E:
 Hosp Univ La Fe, Unidad Microbiol Expt, Valencia 46009, Spain

Peman, J:
 Hosp Univ La Fe, Microbiol Serv, Valencia 46009, Spain

Quindos, G:
 Univ Basque Country, Dept Inmunol Microbiol & Parasitol, Fac Med, E-48080 Bilbao, Spain

Eraso, E:
 Univ Basque Country, Dept Inmunol Microbiol & Parasitol, Fac Med, E-48080 Bilbao, Spain

Miranda-Zapico, I:
 Univ Basque Country, Dept Inmunol Microbiol & Parasitol, Fac Med, E-48080 Bilbao, Spain

Alvarez, M:
 Univ Oviedo, Hosp Cent Asturias, Microbiol Serv, E-33080 Oviedo, Spain

Merino, P:
 Hosp Clin San Carlos, Microbiol Serv, Madrid, Spain

Campos-Herrero, I:
 Hosp Gran Canaria Dr Negrin, Microbiol Serv, Las Palmas Gran Canaria, Spain

Marco, F:
 Hosp Clin Barcelona, Microbiol Serv, Barcelona, Spain

de la Pedrosa, EGG:
 Hosp Ramon & Cajal, Microbiol Serv, E-28034 Madrid, Spain

Yaguue, G:
 Hosp Virgen Arrixaca, Microbiol Serv, Murcia, Spain

Guna, R:
 Gen Hosp, Microbiol Serv, Valencia, Spain

Rubio, C:
 Hosp Clin Lozano Blesa, Microbiol Serv, Zaragoza, Spain

Miranda, C:
 Hosp Virgen Nieves, Microbiol Serv, Granada, Spain

Pazos, C:
 Hosp S Pedro Alcantara, Microbiol Serv, Caceres, Spain

Velasco, D:
 Hosp Lucus Augusti, Microbiol Serv, Lugo, Spain

Sánchez-Reus F.:
 Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
ISSN: 00664804
Editorial
AMER SOC MICROBIOLOGY, 1752 N ST NW, WASHINGTON, DC 20036-2904 USA, Estados Unidos America
Tipo de documento: Article
Volumen: 55 Número: 12
Páginas: 5590-5596
WOS Id: 000296920600023
ID de PubMed: 21930869
imagen Bronze, Green Published

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