The worldwide emergence of multidrug-resistant pathogenic fungi is a threat to human health. At this very moment, an emergence of Candida parapsilosis isolates harboring a resistance to fluconazole, one of the most popular antifungal drugs, is being described in several countries. We seek to better understand the epidemiology, pathogenicity, and transmission of resistant Candida parapsilosis. Faced with an outbreak of invasive infections due to resistant isolates of C. parapsilosis, we performed a 7-year retrospective and prospective analysis of 283 C. parapsilosis isolates collected in 240 patients, among whom 111 had invasive candidiasis. The study included a review of hospital records, genotyping analysis, and susceptibility testing that allowed us to determine the type and outcome of infections, as well as the spatial and temporal spread of clusters. Overall, the incidence of azole resistance was 7.5%. Genotyping analysis unveiled several previously undetected outbreaks and clonal spread of susceptible and resistant isolates over a long period of time. In comparison with susceptible isolates, resistant ones have a more restricted genetic diversity and seem to be more likely to spread and more frequently associated with invasive infections. In intensive care units, patients with invasive infections due to resistant isolates had poorer outcomes (overall mortality at day 30 of 40%; 4/10) than susceptible ones (overall mortality at day 30 of 26.5%; 9/34). Our results suggest that the propensity of C. parapsilosis to spread in an epidemic fashion is underestimated, which warrants reinforced control and epidemiological survey of this species.

中文翻译：

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耐氟康唑近平滑念珠菌的医院暴发：克隆传播和长期持续存在的论据

全球范围内出现的多重耐药病原真菌对人类健康构成威胁。就在此时，几个国家描述了一种对氟康唑（最流行的抗真菌药物之一）具有耐药性的近平滑念珠菌分离株。我们寻求更好地了解耐药性近平滑念珠菌的流行病学、致病性和传播。面对近平滑念珠菌耐药株引起的侵袭性感染暴发，我们对 283近平滑念珠菌进行了为期 7 年的回顾性和前瞻性分析从 240 名患者中收集到分离株，其中 111 名患有侵袭性念珠菌病。该研究包括对医院记录的审查、基因分型分析和易感性测试，使我们能够确定感染的类型和结果，以及集群的空间和时间传播。总的来说，唑类耐药的发生率为 7.5%。基因分型分析揭示了几个以前未检测到的暴发以及易感和耐药菌株在很长一段时间内的克隆传播。与易感菌株相比，耐药菌株的遗传多样性更为有限，似乎更容易传播，并且更频繁地与侵入性感染相关。在重症监护病房中，因耐药菌株导致侵袭性感染的患者预后较差（第 30 天的总死亡率为 40%；4/10) 高于易感者（第 30 天的总死亡率为 26.5%；9/34）。我们的结果表明，倾向C. parapsilosilosis以流行方式传播的可能性被低估，因此需要加强对该物种的控制和流行病学调查。