title: Prospective multicenter study of the epidemiology, molecular identification, and antifungal susceptibility of Candida parapsilosis, Candida orthopsilosis, and Candida metapsilosis isolated from patients with candidemia.
abstract: A 13-month prospective multicenter study including 44 hospitals was carried out to evaluate the epidemiology of Candida parapsilosis complex candidemia in Spain. Susceptibility to amphotericin B, flucytosine, fluconazole, itraconazole, voriconazole, posaconazole, anidulafungin, caspofungin, and micafungin was tested by the microdilution colorimetric method. A total of 364 C. parapsilosis complex isolates were identified by molecular methods: C. parapsilosis (90.7%), Candida orthopsilosis (8.2%), and Candida metapsilosis (1.1%). Most candidemias (C. parapsilosis, 76.4%; C. orthopsilosis, 70.0%; C. metapsilosis, 100%) were observed in adults. No C. orthopsilosis or C. metapsilosis candidemias occurred in neonates. C. parapsilosis was most frequent in adult intensive care unit (28.8%), surgery (20.9%), and internal medicine (19.7%) departments; and C. orthopsilosis was most frequent in hematology (28.6%), pediatrics (12.0%), and neonatology (11.5%) departments. The geographic distribution of C. orthopsilosis and C. metapsilosis was not uniform. According to CLSI clinical breakpoints, all C. orthopsilosis and C. metapsilosis isolates were susceptible to the nine agents tested. Resistance (MICs > 1 mg/liter) was observed only in C. parapsilosis: amphotericin B, posaconazole, itraconazole, and caspofungin (0.3% each), anidulafungin (1.9%), and micafungin (2.5%). Applying the new species-specific fluconazole and echinocandin breakpoints, the rates of resistance to fluconazole for C. parapsilosis and C. orthopsilosis increased to 4.8% and 0.3%, respectively; conversely, for C. parapsilosis they shifted from 1.9 to 0.6% (anidulafungin) and from 2.5 to 0.6% (micafungin). Our study confirms the different prevalence of C. parapsilosis complex candidemia among age groups: neither C. orthopsilosis nor C. metapsilosis was isolated from neonates; interestingly, C. metapsilosis was isolated only from adults and the elderly. The disparity in antifungal susceptibility among species could be important for therapy.
authors.affiliation: Unidad de Microbiología Experimental, Hospital Universitario La Fe, 46009 Valencia, Spain. canton_emi@gva.es
authors.forename: Emilia
authors.initials: E
authors.lastname: Cantón
authors.forename: Javier
authors.initials: J
authors.lastname: Pemán
authors.forename: Guillermo
authors.initials: G
authors.lastname: Quindós
authors.forename: Elena
authors.initials: E
authors.lastname: Eraso
authors.forename: Ilargi
authors.initials: I
authors.lastname: Miranda-Zapico
authors.forename: María
authors.initials: M
authors.lastname: Álvarez
authors.forename: Paloma
authors.initials: P
authors.lastname: Merino
authors.forename: Isolina
authors.initials: I
authors.lastname: Campos-Herrero
authors.forename: Francesc
authors.initials: F
authors.lastname: Marco
authors.forename: Elia Gomez G
authors.initials: EG
authors.lastname: de la Pedrosa
authors.forename: Genoveva
authors.initials: G
authors.lastname: Yagüe
authors.forename: Remedios
authors.initials: R
authors.lastname: Guna
authors.forename: Carmen
authors.initials: C
authors.lastname: Rubio
authors.forename: Consuelo
authors.initials: C
authors.lastname: Miranda
authors.forename: Carmen
authors.initials: C
authors.lastname: Pazos
authors.forename: David
authors.initials: D
authors.lastname: Velasco
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000145:classification / Q000494:pharmacology*; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology*; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D013045:Species Specificity; D055815:Young Adult
chemical_list: D000935:Antifungal Agents