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Inter-Institutional Dynamics and Impact of Fluconazole-Resistant Candida parapsilosis

Maya Korem1,2, Shelly Reich3, Galia Rahav4,5

  • 1Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem, Israel.

Mycoses
|January 8, 2025
PubMed
Abstract

Insights

Fluconazole-resistant Candida parapsilosis infections are increasing in Israeli hospitals. While resistance is linked to microbiological failure, clinical outcomes and mortality were not significantly different, highlighting the need for infection control.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Increasing incidence of fluconazole-resistant Candida parapsilosis bloodstream infections in Israeli hospitals.
  • Unclear impact of azole resistance on patient outcomes.

Purpose of the Study:

  • Determine the frequency, resistance mechanisms, molecular epidemiology, and clinical outcomes of azole-resistant C. parapsilosis bloodstream infections.
  • Investigate risk factors associated with fluconazole resistance.

Main Methods:

  • Collected and analyzed 192 C. parapsilosis isolates from four Israeli hospitals (2005-2022).
  • Performed antifungal susceptibility testing, ERG11 gene sequencing, and multilocus microsatellite genotyping.
  • Utilized logistic regression to identify risk factors and compared clinical outcomes between susceptible and resistant isolates.

Main Results:

  • 41% of C. parapsilosis isolates were resistant to fluconazole, often associated with the ERG11 Y132F substitution.
  • Identified increasing age, ICU stay, haemodialysis, and prior antibiotic use as risk factors for resistance.
  • Nosocomial spread of hospital-specific clones was observed, with resistance linked to higher microbiological failure rates but not clinical outcomes or mortality.

Conclusions:

  • High rates of fluconazole resistance in C. parapsilosis are driven by hospital-acquired infections with specific resistant clones.
  • Fluconazole resistance increases the risk of microbiological treatment failure.
  • Effective strategies are required to curb the nosocomial transmission of C. parapsilosis.
Keywords:
Candida parapsilosisERG11azoleclonefluconazoleoutbreakresistance

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