Changing epidemiology of candidaemia: Increase in fluconazole-resistant Candida parapsilosis.

Abstract

During the last decade a continuous increase in non-albicans species isolation has been observed with Candida parapsilosis being one of the leading species. Aim of this study was to describe the epidemiology of candidemia, particularly of Cparapsilosis, its predictors and clinical outcome. Incidences of candidemia was evaluated analyzing data from both a prospective collection (2012-2016) and a retrospective one (2008-2011). Predictors and outcome were based only on the prospective phase. Cparapsilosis potential clusters were analysed by randomly amplified polymorphic DNA (RAPD) technique. 1240 episodes were identified. Incidences of candidemia increased from 1.97 episodes/10000 patient-days in 2008 to 4.59/10000 patient-days in 2016 (P<.001), mainly due to an increase of Cparapsilosis (incidence rate ratio, IRR: 1.04, P<.001). 33.0% of Cparapsilosis strains were resistant to fluconazole; no resistance to echinocandins was found. Independent predictors of Cparapsilosis candidemia were time of infection (P=.007), previous use of echinocandins (P<.0001) and year in which the episode was registered (P<.0001). 30 days mortality was 32.4% for Cparapsilosis, with a significant difference compared to Cnon-parapsilosis. Potential clonal Cparapsilosis strains were detected by genetic analyses, showing RAPD profile A as the most represented (72.6% of isolates). Cparapsilosis candidemia is an emerging issue in our center, possibly attributed to some extent to horizontal transmission of the pathogen, as confirmed by the analysis of isolates similarities. Further microbiological and epidemiological investigations are needed in order to identify the most effective measures to reduce the rate of this infection.