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Published on: December 28, 2017
A Brazilian Inter-Hospital Candidemia Outbreak Caused by Fluconazole-Resistant Candida parapsilosis in the COVID-19
Danilo Y Thomaz1, Gilda M B Del Negro1, Leidiane B Ribeiro1
1Laboratory of Medical Mycology (LIM-53), Instituto de Medicina Tropical e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-000, Brazil.
Abstract:
Horizontal transmission of fluconazole-resistant Candida parapsilosis (FRCP) through healthcare workers' hands has contributed to the occurrence of candidemia outbreaks worldwide. Since the first COVID-19 case in Brazil was detected in early 2020, hospitals have reinforced hand hygiene and disinfection practices to minimize SARS-CoV-2 contamination. However, a Brazilian cardiology center, which shares ICU patients with a cancer center under a FRCP outbreak since 2019, reported an increased FRCP candidemia incidence in May 2020. Therefore, the purpose of this study was to investigate an inter-hospital candidemia outbreak caused by FRCP isolates during the first year of the COVID-19 pandemic in Brazil. C. parapsilosis bloodstream isolates obtained from the cancer (n = 35) and cardiology (n = 30) centers in 2020 were submitted to microsatellite genotyping and fluconazole susceptibility testing. The ERG11 gene of all isolates from the cardiology center was sequenced and compared to the corresponding sequences of the FRCP genotype responsible for the cancer center outbreak in 2019. Unprecedentedly, most of the FRCP isolates from the cardiology center presented the same genetic profile and Erg11-Y132F mutation detected in the strain that has been causing the persistent outbreak in the cancer center, highlighting the uninterrupted horizontal transmission of clonal isolates in our hospitals during the COVID-19 pandemic.
Insights
Fluconazole-resistant Candida parapsilosis (FRCP) continued spreading between hospitals during the COVID-19 pandemic. Genetic analysis revealed uninterrupted transmission of the same FRCP strain, emphasizing ongoing healthcare-associated infection risks.
Area of Science:
- Infectious Diseases
- Medical Mycology
- Epidemiology
Background:
- Horizontal transmission of fluconazole-resistant Candida parapsilosis (FRCP) via healthcare workers' hands causes candidemia outbreaks.
- Despite enhanced hygiene during COVID-19, a Brazilian cardiology center saw increased FRCP candidemia, sharing patients with a cancer center experiencing a persistent FRCP outbreak since 2019.
Purpose of the Study:
- To investigate an inter-hospital candidemia outbreak caused by FRCP isolates during the first year of the COVID-19 pandemic in Brazil.
Main Methods:
- Microsatellite genotyping and fluconazole susceptibility testing of C. parapsilosis bloodstream isolates from cancer and cardiology centers in 2020.
- Sequencing of the ERG11 gene from cardiology center isolates and comparison with the 2019 cancer center outbreak strain.
Main Results:
- Most FRCP isolates from the cardiology center shared the same genetic profile as the persistent FRCP strain from the cancer center.
- The Erg11-Y132F mutation, characteristic of the cancer center outbreak strain, was also detected in most cardiology center isolates.
Conclusions:
- Highlights the uninterrupted horizontal transmission of clonal FRCP isolates between hospitals during the COVID-19 pandemic.
- Underscores the continued risk of healthcare-associated infections with resistant fungal pathogens even amidst pandemic-related infection control measures.
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