1887

Abstract

Nosocomial fungal bloodstream infections (BSI) are increasing significantly in hospitalized patients and has emerged as an important pathogen responsible for numerous outbreaks. The objective of this study was to evaluate infection scenarios, regarding species distribution and strain relatedness. One hundred isolates of derived from blood cultures and catheter tips were analysed by multiplex microsatellite typing and by sequencing D1/D2 regions of the ribosomal DNA. Our results indicate that 9.5 % of patients presented infections due to and 57.1 % due to , 28.3 % due to and 4.8 % due to . Eighty per cent of the BSIs were due to a single strain that was also identified in the catheter, but in 10 % of the cases was identified in the catheter but the BSI was due to . There is a significant probability that isolates collected from the same patient at more than 3 months interval are of different strains ( = 0.0179). Moreover, several isolates were identified persistently in the same hospital, infecting six different patients. The incidence of polyfungal BSI infections with . and is reported herein for the first time, emphasizing the fact that the species identified in the catheter is not always responsible for the BSI, thus impacting the treatment strategy. The observation that strains can remain in the hospital environment for years highlights the possible existence of reservoirs and reinforces the need for accurate genotyping tools, such as the markers used for elucidating epidemiological associations and detecting outbreaks.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.080655-0
2015-01-01
2019-12-07
Loading full text...

Full text loading...

/deliver/fulltext/jmm/64/1/7.html?itemId=/content/journal/jmm/10.1099/jmm.0.080655-0&mimeType=html&fmt=ahah

References

  1. Aittakorpi A. , Kuusela P. , Koukila-Kähkölä P. , Vaara M. , Petrou M. , Gant V. , Mäki M. . ( 2012; ). Accurate and rapid identification of Candida spp. frequently associated with fungemia by using PCR and the microarray-based Prove-it Sepsis assay. . J Clin Microbiol 50:, 3635–3640. [CrossRef] [PubMed]
    [Google Scholar]
  2. Asadzadeh M. , Ahmad S. , Al-Sweih N. , Khan Z. U. . ( 2009; ). Rapid molecular differentiation and genotypic heterogeneity among Candida parapsilosis and Candida orthopsilosis strains isolated from clinical specimens in Kuwait. . J Med Microbiol 58:, 745–752. [CrossRef] [PubMed]
    [Google Scholar]
  3. Ásmundsdóttir L. R. , Erlendsdóttir H. , Haraldsson G. , Guo H. , Xu J. , Gottfredsson M. . ( 2008; ). Molecular epidemiology of candidemia: evidence of clusters of smoldering nosocomial infections. . Clin Infect Dis 47:, e17–e24. [CrossRef] [PubMed]
    [Google Scholar]
  4. Barchiesi F. , Caggiano G. , Falconi Di Francesco L. , Montagna M. T. , Barbuti S. , Scalise G. . ( 2004; ). Outbreak of fungemia due to Candida parapsilosis in a pediatric oncology unit. . Diagn Microbiol Infect Dis 49:, 269–271. [CrossRef] [PubMed]
    [Google Scholar]
  5. Cantón E. , Pemán J. , Quindós G. , Eraso E. , Miranda-Zapico I. , Álvarez M. , Merino P. , Campos-Herrero I. , Marco F. . & other authors ( 2011; ). Prospective multicenter study of the epidemiology, molecular identification, and antifungal susceptibility of Candida parapsilosis, Candida orthopsilosis, and Candida metapsilosis isolated from patients with candidemia. . Antimicrob Agents Chemother 55:, 5590–5596. [CrossRef] [PubMed]
    [Google Scholar]
  6. Cavalli-Sforza L. L. , Edwards A. W. F. . ( 1967; ). Phylogenetic analysis: models and estimation procedures. . Evolution 21:, 550–570. [CrossRef]
    [Google Scholar]
  7. Colombo A. L. , Nucci M. , Salomão R. , Branchini M. L. , Richtmann R. , Derossi A. , Wey S. B. . ( 1999; ). High rate of non-albicans candidemia in Brazilian tertiary care hospitals. . Diagn Microbiol Infect Dis 34:, 281–286. [CrossRef] [PubMed]
    [Google Scholar]
  8. Delfino D. , Scordino F. , Pernice I. , Lo Passo C. , Galbo R. , David A. , Barberi I. , Criseo G. , Cascio A. , Romeo O. . ( 2014; ). Potential association of specific Candida parapsilosis genotypes, bloodstream infections and colonization of health workers’ hands. . Clin Microbiol Infect doi: 10.1111/1469-0691.12685 [Epub ahead of print]. [CrossRef] [PubMed]
    [Google Scholar]
  9. Diab-Elschahawi M. , Forstner C. , Hagen F. , Meis J. F. , Lassnig A. M. , Presterl E. , Klaassen C. H. . ( 2012; ). Microsatellite genotyping clarified conspicuous accumulation of Candida parapsilosis at a cardiothoracic surgery intensive care unit. . J Clin Microbiol 50:, 3422–3426. [CrossRef] [PubMed]
    [Google Scholar]
  10. Dizbay M. , Kalkanci A. , Sezer B. E. , Aktas F. , Aydogan S. , Fidan I. , Kustimur S. , Sugita T. . ( 2008; ). Molecular investigation of a fungemia outbreak due to Candida parapsilosis in an intensive care unit. . Braz J Infect Dis 12:, 395–399. [CrossRef] [PubMed]
    [Google Scholar]
  11. Escribano P. , Guinea J. , Marcos-Zambrano L. J. , Martín-Rabadán P. , Fernández-Cruz A. , Sánchez-Carrillo C. , Muñoz P. , Bouza E. . ( 2014; ). Is catheter-related candidemia a polyclonal infection. ? Med Mycol 52:, 411–416. [CrossRef] [PubMed]
    [Google Scholar]
  12. Feng X. , Ling B. , Yang G. , Yu X. , Ren D. , Yao Z. . ( 2012; ). Prevalence and distribution profiles of Candida parapsilosis, Candida orthopsilosis and Candida metapsilosis responsible for superficial candidiasis in a Chinese university hospital. . Mycopathologia 173:, 229–234. [CrossRef] [PubMed]
    [Google Scholar]
  13. Garcia-Effron G. , Canton E. , Pemán J. , Dilger A. , Romá E. , Perlin D. S. . ( 2012; ). Epidemiology and echinocandin susceptibility of Candida parapsilosis sensu lato species isolated from bloodstream infections at a Spanish university hospital. . J Antimicrob Chemother 67:, 2739–2748. [CrossRef] [PubMed]
    [Google Scholar]
  14. Gonçalves S. S. , Amorim C. S. , Nucci M. , Padovan A. C. , Briones M. R. , Melo A. S. , Colombo A. L. . ( 2010; ). Prevalence rates and antifungal susceptibility profiles of the Candida parapsilosis species complex: results from a nationwide surveillance of candidaemia in Brazil. . Clin Microbiol Infect 16:, 885–887. [CrossRef] [PubMed]
    [Google Scholar]
  15. Hajjeh R. A. , Sofair A. N. , Harrison L. H. , Lyon G. M. , Arthington-Skaggs B. A. , Mirza S. A. , Phelan M. , Morgan J. , Lee-Yang W. . & other authors ( 2004; ). Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program. . J Clin Microbiol 42:, 1519–1527. [CrossRef] [PubMed]
    [Google Scholar]
  16. Hunter P. R. , Gaston M. A. . ( 1988; ). Numerical index of the discriminatory ability of typing systems: an application of Simpson’s index of diversity. . J Clin Microbiol 26:, 2465–2466.[PubMed]
    [Google Scholar]
  17. Kim H. K. , Park Y. K. , Wang H. J. , Kim B. W. , Shin S. Y. , Lim S. K. , Choi Y. H. . ( 2013; ). Epidemiology and clinical features of post-transplant bloodstream infection: an analysis of 222 consecutive liver transplant recipients. . Infect Chemother 45:, 315–324. [CrossRef] [PubMed]
    [Google Scholar]
  18. Lagrou K. , Verhaegen J. , Peetermans W. E. , De Rijdt T. , Maertens J. , Van Wijngaerden E. . ( 2007; ). Fungemia at a tertiary care hospital: incidence, therapy, and distribution and antifungal susceptibility of causative species. . Eur J Clin Microbiol Infect Dis 26:, 541–547. [CrossRef] [PubMed]
    [Google Scholar]
  19. Lattif A. A. , Mukherjee P. K. , Chandra J. , Swindell K. , Lockhart S. R. , Diekema D. J. , Pfaller M. A. , Ghannoum M. A. . ( 2010; ). Characterization of biofilms formed by Candida parapsilosis, C. metapsilosis, and C. orthopsilosis . . Int J Med Microbiol 300:, 265–270. [CrossRef] [PubMed]
    [Google Scholar]
  20. Lockhart S. R. , Iqbal N. , Cleveland A. A. , Farley M. M. , Harrison L. H. , Bolden C. B. , Baughman W. , Stein B. , Hollick R. . & other authors ( 2012; ). Species identification and antifungal susceptibility testing of Candida bloodstream isolates from population-based surveillance studies in two U.S. cities from 2008 to 2011. . J Clin Microbiol 50:, 3435–3442. [CrossRef] [PubMed]
    [Google Scholar]
  21. Lupetti A. , Tavanti A. , Davini P. , Ghelardi E. , Corsini V. , Merusi I. , Boldrini A. , Campa M. , Senesi S. . ( 2002; ). Horizontal transmission of Candida parapsilosis candidemia in a neonatal intensive care unit. . J Clin Microbiol 40:, 2363–2369. [CrossRef] [PubMed]
    [Google Scholar]
  22. Maganti H. , Yamamura D. , Xu J. . ( 2011; ). Prevalent nosocomial clusters among causative agents for candidemia in Hamilton, Canada. . Med Mycol 49:, 530–538.[PubMed]
    [Google Scholar]
  23. Nucci M. , Queiroz-Telles F. , Alvarado-Matute T. , Tiraboschi I. N. , Cortes J. , Zurita J. , Guzman-Blanco M. , Santolaya M. E. , Thompson L. . & other authors ( 2013; ). Epidemiology of candidemia in Latin America: a laboratory-based survey. . PLoS ONE 8:, e59373. [CrossRef] [PubMed]
    [Google Scholar]
  24. Parmeland L. , Gazon M. , Guerin C. , Argaud L. , Lehot J. J. , Bastien O. , Allaouchiche B. , Michallet M. , Picot S. , Bienvenu A. L. . Study Group ( 2013; ). Candida albicans and non-Candida albicans fungemia in an institutional hospital during a decade. . Med Mycol 51:, 33–37. [CrossRef] [PubMed]
    [Google Scholar]
  25. Pfaller M. A. , Diekema D. J. . ( 2007; ). Epidemiology of invasive candidiasis: a persistent public health problem. . Clin Microbiol Rev 20:, 133–163. [CrossRef] [PubMed]
    [Google Scholar]
  26. Romeo O. , Delfino D. , Cascio A. , Lo Passo C. , Amorini M. , Romeo D. , Pernice I. . ( 2013; ). Microsatellite-based genotyping of Candida parapsilosis sensu stricto isolates reveals dominance and persistence of a particular epidemiological clone among neonatal intensive care unit patients. . Infect Genet Evol 13:, 105–108. [CrossRef] [PubMed]
    [Google Scholar]
  27. Sabino R. , Sampaio P. , Rosado L. , Stevens D. A. , Clemons K. V. , Pais C. . ( 2010; ). New polymorphic microsatellite markers able to distinguish among Candida parapsilosis sensu stricto isolates. . J Clin Microbiol 48:, 1677–1682. [CrossRef] [PubMed]
    [Google Scholar]
  28. Sabino R. , Sampaio P. , Carneiro C. , Rosado L. , Pais C. . ( 2011; ). Isolates from hospital environments are the most virulent of the Candida parapsilosis complex. . BMC Microbiol 11:, 180. [CrossRef] [PubMed]
    [Google Scholar]
  29. Shin J. H. , Park M. R. , Song J. W. , Shin D. H. , Jung S. I. , Cho D. , Kee S. J. , Shin M. G. , Suh S. P. , Ryang D. W. . ( 2004; ). Microevolution of Candida albicans strains during catheter-related candidemia. . J Clin Microbiol 42:, 4025–4031. [CrossRef] [PubMed]
    [Google Scholar]
  30. Tragiannidis A. , Fegeler W. , Rellensmann G. , Debus V. , Müller V. , Hoernig-Franz I. , Siam K. , Pana Z. D. , Jürgens H. , Groll A. H. . ( 2012; ). Candidaemia in a European Paediatric University Hospital: a 10-year observational study. . Clin Microbiol Infect 18:, E27–E30. [CrossRef] [PubMed]
    [Google Scholar]
  31. Tumbarello M. , Posteraro B. , Trecarichi E. M. , Fiori B. , Rossi M. , Porta R. , de Gaetano Donati K. , La Sorda M. , Spanu T. . & other authors ( 2007; ). Biofilm production by Candida species and inadequate antifungal therapy as predictors of mortality for patients with candidemia. . J Clin Microbiol 45:, 1843–1850. [CrossRef] [PubMed]
    [Google Scholar]
  32. van Asbeck E. C. , Clemons K. V. , Stevens D. A. . ( 2009; ). Candida parapsilosis: a review of its epidemiology, pathogenesis, clinical aspects, typing and antimicrobial susceptibility. . Crit Rev Microbiol 35:, 283–309. [CrossRef] [PubMed]
    [Google Scholar]
  33. Vaz C. , Sampaio P. , Clemons K. V. , Huang Y. C. , Stevens D. A. , Pais C. . ( 2011; ). Microsatellite multilocus genotyping clarifies the relationship of Candida parapsilosis strains involved in a neonatal intensive care unit outbreak. . Diagn Microbiol Infect Dis 71:, 159–162. [CrossRef] [PubMed]
    [Google Scholar]
  34. Viviani M. A. , Cogliati M. , Esposto M. C. , Prigitano A. , Tortorano A. M. . ( 2006; ). Four-year persistence of a single Candida albicans genotype causing bloodstream infections in a surgical ward proven by multilocus sequence typing. . J Clin Microbiol 44:, 218–221. [CrossRef] [PubMed]
    [Google Scholar]
  35. Wu J. Q. , Zhu L. P. , Ou X. T. , Xu B. , Hu X. P. , Wang X. , Weng X. H. . ( 2011; ). Epidemiology and risk factors for non-Candida albicans candidemia in non-neutropenic patients at a Chinese teaching hospital. . Med Mycol 49:, 552–555.[PubMed]
    [Google Scholar]
  36. Xess I. , Jain N. , Hasan F. , Mandal P. , Banerjee U. . ( 2007; ). Epidemiology of candidemia in a tertiary care centre of north India: 5-year study. . Infection 35:, 256–259. [CrossRef] [PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.080655-0
Loading
/content/journal/jmm/10.1099/jmm.0.080655-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error