BACKGROUND Despite being associated with a high mortality and economic burden, data regarding candidemia are scant in Algeria. The aim of this study was to unveil the epidemiology of candidemia in Algeria, evaluate the antifungal susceptibility pattern of causative agents and understand the molecular mechanisms of antifungal resistance where applicable. Furthermore, by performing environmental screening and microsatellite typing we sought to identify the source of infection. METHODS We performed a retrospective epidemiological-based surveillance study and collected available blood yeast isolates recovered from the seven hospitals in Algiers. To identify the source of infection, we performed environmental screening from the hands of healthcare workers (HCWs) and high touch areas. Species identification was performed by API Auxa-Color and MALDI-TOF MS and ITS sequencing was performed for species not reliably identified by MALDI-TOF MS. Antifungal susceptibility testing followed CLSI M27-A3/S4 and included all blood and environmental yeast isolates. ERG11 sequencing was performed for azole-resistant Candida isolates. Microsatellite typing was performed for blood and environmental Candida species, where applicable. RESULTS Candida tropicalis (19/66) was the main cause of candidemia in these seven hospitals, followed by Candida parapsilosis (18/66), Candida albicans (18/66), and Candida glabrata (7/66). The overall mortality rate was 68.6% (35/51) and was 81.2% for C. tropicalis-infected patients (13/16). Fluconazole was the main antifungal drug used (12/51); 41% of the patients (21/51) did not receive any systemic treatment. Candida parapsilosis was isolated mainly from the hands of HCWs (7/28), and various yeasts were collected from high-touch areas (11/47), including Naganishia albida, C. parapsilosis and C. glabrata. Typing data revealed interhospital transmission on two occasions for C. parapsilosis and C. glabrata, and the same clone of C. parapsilosis infected two patients within the same hospital. Resistance was only noted for C. tropicalis against azoles (6/19) and fluconazole-resistant C. tropicalis isolates (≥8 μg/ml) (6/19) contained a novel P56S (5/6) amino acid substitution and a previously reported one (V234F; 1/6) in Erg11p. CONCLUSIONS Collectively, our data suggest an urgent need for antifungal stewardship and infection control strategies to improve the clinical outcome of Algerian patients with candidemia. The high prevalence of C. tropicalis joined by fluconazole-resistance may hamper the therapeutic efficacy of fluconazole, the frontline antifungal drug used in Algeria.

中文翻译：

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热带念珠菌是导致阿尔及利亚念珠菌血症的最普遍的酵母菌种：迫切需要抗真菌治疗和感染控制措施。

背景技术尽管与高死亡率和经济负担相关联，但是关于阿尔及利亚念珠菌血症的数据很少。这项研究的目的是揭示阿尔及利亚念珠菌病的流行病学，评估病原体的抗真菌药敏模式，并在适用的情况下了解抗真菌耐药性的分子机制。此外，通过进行环境筛选和微卫星分型，我们试图确定感染源。方法我们进行了一项基于流行病学的回顾性监测研究，并收集了从阿尔及尔的七家医院回收的血酵母分离株。为了确定感染源，我们从医护人员（HCW）和高接触区域进行了环境筛查。通过API Auxa-Color和MALDI-TOF MS进行物种鉴定，对MALDI-TOF MS无法可靠鉴定的物种进行ITS测序。在CLSI M27-A3 / S4之后进行了抗真菌药敏试验，包括所有血液和环境酵母分离株。对耐唑类念珠菌分离株进行ERG11测序。如果适用，对血液和环境念珠菌进行微卫星分型。结果在这七家医院中，热带念珠菌（19/66）是念珠菌血症的主要原因，其次是副念珠菌（18/66），白色念珠菌（18/66）和光滑念珠菌（7/66）。总体死亡率为68.6％（35/51），热带感染小球藻的患者为81.2％（13/16）。氟康唑是使用的主要抗真菌药物（12/51）；41％的患者（21/51）未接受任何全身治疗。副念珠菌主要是从医护人员手中分离出来的（7/28），并且从高接触区（11/47）收集了各种酵母菌，包括白gan（Naganishia albida），副念珠菌（C. parapsilosis）和光滑念珠菌（C. glabrata）。打字数据显示，两次寄生虫病和光滑毛虫的医院间传播，同一寄生虫感染的克隆感染了同一家医院的两名患者。仅注意到热带假丝酵母对唑类的抗性（6/19）和耐氟康唑的热带假丝酵母分离株（≥8μg/ ml）（6/19）包含新的P56S（5/6）氨基酸取代，且以前在Erg11p中报告了一个（V234F; 1/6）。结论总体而言，我们的数据表明迫切需要抗真菌治疗和感染控制策略，以改善阿尔及利亚念珠菌血症患者的临床结局。C的高患病率。