Molecular and Epidemiological Investigation of Fluconazole-resistant Candida parapsilosis —Georgia, United States, 2021

Abstract Background Reports of fluconazole-resistant Candida parapsilosis bloodstream infections are increasing. We describe a cluster of fluconazole-resistant C parapsilosis bloodstream infections identified in 2021 on routine surveillance by the Georgia Emerging Infections Program in conjunction w...

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Bibliographic Details
Published in:Open forum infectious diseases 2024-06, Vol.11 (6), p.ofae264-ofae264
Main Authors: Misas, Elizabeth, Witt, Lucy S, Farley, Monica M, Thomas, Stepy, Jenkins, Emily N, Gade, Lalitha, Peterson, Joyce G, Restrepo, Ana Mesa, Fridkin, Scott, Lockhart, Shawn R, Chow, Nancy A, Lyman, Meghan
Format: Article
Language:English
Subjects:
Analysis
Antimicrobial Resistance
Brazil
DNA sequencing
Editor's Choice
Epidemiology
Fluconazole
Genomes
Genomics
Health aspects
Hospitals
Infection
Investigations
Medical records
Nucleotide sequencing
Social networks
Tazobactam
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Summary:Abstract Background Reports of fluconazole-resistant Candida parapsilosis bloodstream infections are increasing. We describe a cluster of fluconazole-resistant C parapsilosis bloodstream infections identified in 2021 on routine surveillance by the Georgia Emerging Infections Program in conjunction with the Centers for Disease Control and Prevention. Methods Whole-genome sequencing was used to analyze C parapsilosis bloodstream infections isolates. Epidemiological data were obtained from medical records. A social network analysis was conducted using Georgia Hospital Discharge Data. Results Twenty fluconazole-resistant isolates were identified in 2021, representing the largest proportion (34%) of fluconazole-resistant C parapsilosis bloodstream infections identified in Georgia since surveillance began in 2008. All resistant isolates were closely genetically related and contained the Y132F mutation in the ERG11 gene. Patients with fluconazole-resistant isolates were more likely to have resided at long-term acute care hospitals compared with patients with susceptible isolates (P = .01). There was a trend toward increased mechanical ventilation and prior azole use in patients with fluconazole-resistant isolates. Social network analysis revealed that patients with fluconazole-resistant isolates interfaced with a distinct set of healthcare facilities centered around 2 long-term acute care hospitals compared with patients with susceptible isolates. Conclusions Whole-genome sequencing results showing that fluconazole-resistant C parapsilosis isolates from Georgia surveillance demonstrated low genetic diversity compared with susceptible isolates and their association with a facility network centered around 2 long-term acute care hospitals suggests clonal spread of fluconazole-resistant C parapsilosis. Further studies are needed to better understand the sudden emergence and transmission of fluconazole-resistant C parapsilosis.
ISSN:2328-8957
2328-8957
DOI:10.1093/ofid/ofae264