The most prevalent cause of nosocomial bloodstream infection (BSI) among non-C. albicans Candida species, Candida parapsilosis, may not only be resistant to azole antifungal agents but also disseminate to vulnerable patients. In this survey of BSIs occurring at a large Italian hospital between May 2014 and May 2019, C. parapsilosis accounted for 28.5% (241/844) of all Candida isolates causing BSI episodes. The majority of episodes (151/844) occurred in medical wards. Across the 5 yearly periods, the rates of azole non-susceptibility were 11.8% (4/34), 17.8% (8/45), 28.6% (12/42), 32.8% (19/58), and 17.7% (11/62), respectively, using the Sensititre YeastOne® method. Among azole non-susceptible isolates (54/241; 22.4%), 49 were available for further investigation. Using the CLSI reference method, all 49 isolates were resistant to fluconazole and, except one (susceptible dose-dependent), to voriconazole. Forty (81.6%) isolates harbored the Erg11p Y132F substitution and nine (18.4%) isolates the Y132F in combination with the Erg11p R398I substitution. According to their genotypes, as defined using a microsatellite analysis based on six short tandem repeat markers, 87.7% of isolates (43/49) grouped in two major clusters (II and III), whereas 4.1% of isolates (2/49) belonged to a separate cluster (I). Interestingly, all the isolates from cluster II harbored the Y132F substitution, and those from cluster III harbored both Y132F and R398I substitutions. Of 56 non-Italian isolates included as controls, two Indian isolates with the Y132F substitution had a genotype clearly differing from that of the isolates from clusters II and I. In conclusion, these findings show the dominance of clonal Y132F isolates in our hospital and suggest detection of the Y132F substitution as helpful tool to prevent transmission among hospitalized patients at risk of BSI.

中文翻译：

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意大利一家大型医院中抗唑类近平滑念珠菌的流行率和克隆分布导致血流感染。

非 C 中医院内血流感染 (BSI) 的最常见原因。白色念珠菌种，近平滑念珠菌，可能不仅对唑类抗真菌剂具有抗性，而且还会传播给易感患者。在这项对 2014 年 5 月至 2019 年 5 月期间在意大利一家大型医院发生的 BSI 的调查中，近平滑念珠菌占导致 BSI 发作的所有念珠菌分离株的 28.5% (241/844)。大多数事件 (151/844) 发生在医疗病房。在 5 年期间，唑类非敏感性率为 11.8% (4/34)、17.8% (8/45)、28.6% (12/42)、32.8% (19/58) 和 17.7% ( 11/62)，分别使用 Sensititre YeastOne® 方法。在唑类非敏感分离株（54/241；22.4%）中，49 株可用于进一步调查。使用 CLSI 参考方法，所有 49 个分离株都对氟康唑耐药，并且，除了一种（易感的剂量依赖性），伏立康唑。四十 (81.6%) 株含有 Erg11p Y132F 取代和九 (18.4%) 株 Y132F 与 Erg11p R398I 取代组合。根据它们的基因型，使用基于六个短串联重复标记的微卫星分析定义，87.7% 的分离株 (43/49) 分为两个主要簇 (II 和 III)，而 4.1% 的分离株 (2/49) 属于到一个单独的集群 (I)。有趣的是，来自第 II 类的所有分离株都含有 Y132F 替代，来自第 III 类的所有分离物均含有 Y132F 和 R398I 替代。在包括作为对照的 56 个非意大利分离株中，两个带有 Y132F 取代的印度分离株的基因型与来自簇 II 和 I 的分离株的基因型明显不同。 总之，