title: Prevalence and antifungal susceptibility patterns of new cryptic species inside the species complexes Candida parapsilosis and Candida glabrata among blood isolates from a Spanish tertiary hospital.
abstract: OBJECTIVE
  There is scarce information on the clinical relevance and antifungal susceptibility of Candida bracarensis, Candida nivariensis, Candida orthopsilosis and Candida metapsilosis. The objective of this study was to assess the prevalence and in vitro antifungal susceptibility of these cryptic species among 173 blood isolates previously identified as Candida glabrata or Candida parapsilosis at the Hospital of Cruces (Barakaldo, Spain). The survey was extended to 518 clinical isolates from the culture collection of the Universidad del País Vasco-Euskal Herriko Unibertsitatea (UPV-EHU; Bilbao, Spain).
  
  
  METHODS
  In vitro susceptibilities to 5-fluorocytosine, amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole, micafungin, posaconazole and voriconazole were tested.
  
  
  RESULTS
  All isolates of C. glabrata were identified as C. glabrata sensu stricto. Inside the C. parapsilosis complex, 2.4% of isolates from the Hospital of Cruces and 5.8% from the UPV-EHU were C. metapsilosis or C. orthopsilosis. Of 457 isolates, 435 (95.19%) were C. parapsilosis sensu stricto, 11 (2.41%) C. metapsilosis and 11 (2.41%) C. orthopsilosis. Only seven blood isolates were C. metapsilosis (0.44%) or C. orthopsilosis (1.09%). These cryptic species were also isolated from other relevant clinical specimens. Four C. parapsilosis sensu stricto (5.6%) were susceptible dose-dependent, and one was resistant to both fluconazole and voriconazole (1.4%). Moreover, 19 isolates of C. parapsilosis sensu stricto (26.4%) were intermediately susceptible to itraconazole and higher concentrations of echinocandins were needed to inhibit this species. Most C. orthopsilosis and C. metapsilosis were susceptible to all antifungal agents tested, but one otic isolate of C. metapsilosis was resistant to fluconazole and 5-fluorocytosine.
  
  
  CONCLUSIONS
  C. metapsilosis and C. orthopsilosis are associated with human disease and show a different antifungal susceptibility profile compared with C. parapsilosis sensu stricto.
authors.affiliation: Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain.
authors.forename: Ilargi
authors.initials: I
authors.lastname: Miranda-Zapico
authors.forename: Elena
authors.initials: E
authors.lastname: Eraso
authors.forename: José Luis
authors.initials: JL
authors.lastname: Hernández-Almaraz
authors.forename: Leyre Mónica
authors.initials: LM
authors.lastname: López-Soria
authors.forename: Alfonso Javier
authors.initials: AJ
authors.lastname: Carrillo-Muñoz
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Hernández-Molina
authors.forename: Guillermo
authors.initials: G
authors.lastname: Quindós
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D001769:Blood / Q000382:microbiology*; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification*; D041221:Candida glabrata / Q000187:drug effects / Q000302:isolation & purification; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D026141:Drug Resistance, Multiple, Fungal; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests; D013030:Spain / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents