Clonal outbreaks of fluconazole-resistant (FLZR) Candida parapsilosis isolates have been reported in several countries. Despite its being the second leading cause of candidemia, the azole resistance mechanisms and the clonal expansion of FLZR C. parapsilosis blood isolates have not been reported in Turkey. In this study, we consecutively collected C. parapsilosis blood isolates (n = 225) from the fifth largest hospital in Turkey (2007 to 2019), assessed their azole susceptibility pattern using CLSI M27-A3/S4, and sequenced ERG11 for all and MRR1, TAC1, and UPC2 for a selected number of C. parapsilosis isolates. The typing resolution of two widely used techniques, amplified fragment length polymorphism typing (AFLP) and microsatellite typing (MST), and the biofilm production of FLZR isolates with and without Y132F were compared. Approximately 27% of isolates were FLZR (60/225), among which 90% (54/60) harbored known mutations in Erg11, including Y132F (24/60) and Y132F+K143R (19/60). Several mutations specific to FLZR isolates were found in MRR1, TAC1, and UPC2. AFLP grouped isolates into two clusters, while MST revealed several clusters. The majority of Y132F/Y132F+K143R isolates grouped in clonal clusters, which significantly expanded throughout 2007 to 2019 in neonatal wards. Candida parapsilosis isolates carrying Y132F were associated with significantly higher mortality and less biofilm production than other FLZR isolates. Collectively, we documented the first outbreak of FLZR C. parapsilosis blood isolates in Turkey. The MRR1, TAC1, and UPC2 mutations exclusively found in FLZR isolates establishes a basis for future studies, which will potentially broaden our knowledge of FLZR mechanisms in C. parapsilosis. MST should be a preferred method for clonal analysis of C. parapsilosis isolates in outbreak scenarios.

中文翻译：

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由耐氟康唑耐药的假丝酵母念珠菌引起的念珠菌无性系爆发的第一份报告分离出了土耳其的Y132F和/或Y132F + K143R。

几个国家已经报告了耐氟康唑（FLZR）副念珠菌分离株的克隆暴发。尽管它是念珠菌的第二大原因，唑类耐药机制和FLZR的克隆扩增近平滑念珠菌血液分离尚未见报道在土耳其。在这项研究中，我们收集连续近平滑念珠菌血液分离株（ñ = 225）从土耳其（二○○七年至2019年）的第五大医院检查，评估使用CLSI M27-A3 / S4他们唑敏感性模式，并进行测序ERG11所有和MRR1，TAC1和UPC2用于选定数量的副枝梭菌隔离株。比较了两种广泛使用的技术的分型分辨率：扩增片段长度多态性分型（AFLP）和微卫星分型（MST），以及有无Y132F的FLZR分离株的生物膜产量。大约27％的分离株是FLZR（60/225），其中90％（54/60）带有Erg11中的已知突变，包括Y132F（24/60）和Y132F + K143R（19/60）。在MRR1，TAC1和UPC2中发现了一些针对FLZR分离株的突变。AFLP将分离株分为两个簇，而MST显示了几个簇。大多数Y132F / Y132F + K143R分离株以克隆簇的形式出现，在2007年至2019年期间在新生儿病房中显着扩展。副念珠菌与其他FLZR分离株相比，带有Y132F的分离株与更高的死亡率和更少的生物膜产量相关。总的来说，我们记录FLZR的第一次爆发近平滑念珠菌在土耳其的血液分离。仅在FLZR分离株中发现的MRR1，TAC1和UPC2突变为将来的研究奠定了基础，这将有可能拓宽我们对副翼念珠菌FLZR机制的认识。MST应该是在暴发情况下对副寄生虫分离株进行克隆分析的首选方法。