title: Molecular Identification and Echinocandin Susceptibility of Candida parapsilosis Complex Bloodstream Isolates in Italy, 2007-2014.
abstract: The Candida parapsilosis group encompasses three species: C. parapsilosis, C. orthopsilosis, and C. metapsilosis. Here, we describe the incidence and echinocandin susceptibility profile of bloodstream isolates of these three species collected from patients admitted to an Italian university hospital from 2007 to 2014. Molecular identification of cryptic species of the C. parapsilosis complex was performed using polymerase chain reaction amplification of the gene encoding secondary alcohol dehydrogenase, followed by digestion with the restriction enzyme BanI. Minimum inhibitory concentrations were determined using the broth microdilution method according to European Committee for Antimicrobial Susceptibility Testing (EUCAST EDef 7.2) and Clinical Laboratory Standards Institute (CLSI M27-A3) guidelines, and the results were compared with those obtained using the E-test and Sensititre methods. Of the 163 C. parapsilosis complex isolates, 136 (83.4%) were identified as C. parapsilosis, and 27 (16.6%) as C. orthopsilosis. The species-specific incidences were 2.9/10,000 admissions for C. parapsilosis and 0.6/10,000 admissions for C. orthopsilosis. No resistance to echinocandins was detected with any of the methods. The percent essential agreement (EA) between the EUCAST and E-test/Sensititre methods for anidulafungin, caspofungin, and micafungin susceptibility was, respectively, as follows: C. parapsilosis, 95.6/97.8, 98.5/88.2, and 93.4/96.3; C. orthopsilosis, 92.6/92.6, 96.3/77.8, and 63.0/66.7. The EA between the CLSI and E-test/Sensititre methods was, respectively, as follows: C. parapsilosis, 99.3/100, 98.5/89.0, and 96.3/98.5; C. orthopsilosis, 96.3/92.6, 100/81.5, and 92.6/88.9. Only minor discrepancies, ranging from 16.9% (C. parapsilosis) to 11.1% (C. orthopsilosis), were observed between the CLSI and E-test/Sensititre methods. In conclusion, this epidemiologic study shows a typical C. parapsilosis complex species distribution, no echinocandin resistance, and it reinforces the relevance of using commercially available microbiological methods to assess antifungal susceptibility. These data improve our knowledge of the national distribution of species of the psilosis group, as there are very few studies of these species in Italy.
authors.affiliation: Department of Biomedical Science and Human Oncology, Hygiene Section, Università degli Studi of Bari "Aldo Moro", Bari, Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Lovero
authors.affiliation: Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Borghi
authors.affiliation: Department of Biomedical Science and Human Oncology, Hygiene Section, Università degli Studi of Bari "Aldo Moro", Bari, Italy.
authors.forename: Stella
authors.initials: S
authors.lastname: Balbino
authors.affiliation: Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Cirasola
authors.affiliation: Department of Biomedical Science and Human Oncology, Hygiene Section, Università degli Studi of Bari "Aldo Moro", Bari, Italy.
authors.forename: Osvalda
authors.initials: O
authors.lastname: De Giglio
authors.affiliation: Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Perdoni
authors.affiliation: Department of Biomedical Science and Human Oncology, Hygiene Section, Università degli Studi of Bari "Aldo Moro", Bari, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Caggiano
authors.affiliation: Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Morace
authors.affiliation: Department of Biomedical Science and Human Oncology, Hygiene Section, Università degli Studi of Bari "Aldo Moro", Bari, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Montagna
mesh_terms: D000429:Alcohol Oxidoreductases / Q000235:genetics; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D058387:Candidemia / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D015252:Deoxyribonucleases, Type II Site-Specific; D054714:Echinocandins / Q000494:pharmacology*; D005656:Fungal Proteins / Q000235:genetics; D005800:Genes, Fungal; D006785:Hospitals, University; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D011446:Prospective Studies; D013045:Species Specificity
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D005656:Fungal Proteins; D000429:Alcohol Oxidoreductases; C025192:isopropanol dehydrogenase (NADP); C051612:endodeoxyribonuclease BanI; D015252:Deoxyribonucleases, Type II Site-Specific