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Evaluation of Molecular Epidemiology, Clinical Characteristics, Antifungal Susceptibility Profiles, and Molecular Mechanisms of Antifungal Resistance of Iranian Candida Parapsilosis Species Complex Blood Isolates Publisher Pubmed



Arastehfar A1 ; Daneshnia F1 ; Najafzadeh MJ2 ; Hagen F1, 3, 4 ; Mahmoudi S5 ; Salehi M6 ; Zarrinfar H7 ; Namvar Z8 ; Zareshahrabadi Z9 ; Khodavaisy S10 ; Zomorodian K9 ; Pan W11 ; Theelen B1 ; Kostrzewa M12 Show All Authors
Authors
  1. Arastehfar A1
  2. Daneshnia F1
  3. Najafzadeh MJ2
  4. Hagen F1, 3, 4
  5. Mahmoudi S5
  6. Salehi M6
  7. Zarrinfar H7
  8. Namvar Z8
  9. Zareshahrabadi Z9
  10. Khodavaisy S10
  11. Zomorodian K9
  12. Pan W11
  13. Theelen B1
  14. Kostrzewa M12
  15. Boekhout T1, 13
  16. Lassflorl C14
Show Affiliations
Authors Affiliations
  1. 1. Yeast Biodiversity Department, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
  2. 2. Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  3. 3. Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
  4. 4. Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
  5. 5. Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  7. 7. Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
  8. 8. Department of Microbiology, School of Biological Sciences, Islamic Azad University, Tehran, Iran
  9. 9. Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  10. 10. Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  11. 11. Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
  12. 12. Bruker Daltonik GmbH, Bremen, Germany
  13. 13. Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, Netherlands
  14. 14. Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria

Source: Frontiers in Cellular and Infection Microbiology Published:2020


Abstract

Clonal expansion of fluconazole resistant (FLZ-R) Candida parapsilosis isolates is increasingly being identified in many countries, while there is no study exploring the antifungal susceptibility pattern, genetic diversity, and clinical information for Iranian C. parapsilosis blood isolates. Candida parapsilosis species complex blood isolates (n = 98) were recovered from nine hospitals located in three major cities, identified by MALDI-TOF MS, and their genetic relatedness was examined by AFLP fingerprinting. Antifungal susceptibility testing followed CLSI-M27-A3 and ERG11, MRR1 and hotspots 1/2 (HS1/2) of FKS1 were sequenced to assess the azole and echinocandin resistance mechanisms, respectively. Ninety-four C. parapsilosis and four Candida orthopsilosis isolates were identified from 90 patients. Only 43 patients received systemic antifungal drugs with fluconazole as the main antifungal used. The overall mortality rate was 46.6% (42/90) and death mostly occurred for those receiving systemic antifungals (25/43) relative to those not treated (17/47). Although, antifungal-resistance was rare, one isolate was multidrug-resistant (FLZ = 16 μg/ml and micafungin = 8 μg/ml) and the infected patient showed therapeutic failure to FLZ prophylaxis. Mutations causing azole and echinocandin resistance were not found in the genes studied. AFLP revealed five genotypes (G) and G1 was the main one (59/94; 62.7%). Clinical outcome was significantly associated with city (P = 0.02, α <0.05) and Mashhad was significantly associated with mortality (P = 0.03, α <0.05). Overall, we found a low level of antifungal resistance for Iranian C. parapsilosis blood isolates, but the noted MDR strain can potentially become the source of future infections and challenge the antifungal therapy in antifungal-naive patients. AFLP typing results warrants confirmation using other resolutive typing methods. © Copyright © 2020 Arastehfar, Daneshnia, Najafzadeh, Hagen, Mahmoudi, Salehi, Zarrinfar, Namvar, Zareshahrabadi, Khodavaisy, Zomorodian, Pan, Theelen, Kostrzewa, Boekhout and Lass-Florl.
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