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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.
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.
Afiliación
  • Thomaz DY; 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.
  • de Almeida JN; 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.
  • Sejas ONE; Central Laboratory Division (LIM-03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil.
  • Del Negro GMB; Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA.
  • Carvalho GOMH; Cancer Institute of São Paulo State, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil.
  • Gimenes VMF; 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.
  • de Souza MEB; 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.
  • Arastehfar A; 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.
  • Camargo CH; Cancer Institute of São Paulo State, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil.
  • Motta AL; Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA.
  • Rossi F; Bacteriology Center, Instituto Adolfo Lutz, São Paulo 01246-000, Brazil.
  • Perlin DS; Central Laboratory Division (LIM-03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil.
  • Freire MP; Central Laboratory Division (LIM-03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil.
  • Abdala E; Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA.
  • Benard G; Cancer Institute of São Paulo State, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil.
J Fungi (Basel) ; 7(4)2021 Mar 30.
Article en En | MEDLINE | ID: mdl-33808442
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE País/Región como asunto: America do sul / Brasil Idioma: En Revista: J Fungi (Basel) Año: 2021 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Suiza

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE País/Región como asunto: America do sul / Brasil Idioma: En Revista: J Fungi (Basel) Año: 2021 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Suiza