Clonal spread of fluconazole‐resistant C. parapsilosis in patients admitted to a referral hospital located in Burgos, Spain, during the COVID‐19 pandemic

Abstract

BackgroundFluconazole‐resistant Candida parapsilosis (FRCP) is a matter of concern in Spain.ObjectivesWe here report a FRCP spread across a 777‐bed referral hospital located in Burgos, Spain, during the COVID‐19 pandemic.Patients/MethodsIn April 2021, an FRCP isolate (MIC = 64 mg/L, E‐test®) from a hospitalised patient was detected. Up to June 2022, all C. parapsilosis isolates (n = 35) from hospitalised patients (n = 32) were stored and genotyped using microsatellite markers, and their antifungal susceptibilities were studied (EUCAST); FRCP isolates were molecularly characterised.ResultsWe detected 26 FRCP isolates collected between 2021 (n = 8) and 2022 (n = 18); isolates were susceptible to amphotericin B, echinocandins and ibrexafungerp. FRCP isolates were grouped into three genotypes: CP‐707 and CP‐708 involved isolates harbouring the Y132F + R398I ERG11p substitutions (n = 24) and were clonally related; the remaining CP‐675 genotype involved isolates harbouring the G458S ERG11p substitution (n = 2). FRCP genotypes were genetically related to the FRCP genotypes found in Madrid and were unrelated to fluconazole‐susceptible ones. Patients harbouring FRCP were mainly (n = 22/23) admitted to intensive care units. Most patients had received broad‐spectrum antibiotics (n = 22/23), and/or antifungal therapy with azoles (n = 14/23) within the 30 days prior to FRCP isolation. Thirteen patients were colonised, 10 of whom were infected and presented candidaemia (n = 8/10), endovascular infection (n = 1/10) or complicated urinary infection (n = 1/10). Overall nonattributable 30‐day mortality was 17% (n = 4/23).ConclusionsWe report an outbreak caused by FRCP affecting patients admitted to the ICU of a referral hospital located in Burgos. Patients harbouring FRCP had a higher fluconazole use than those carrying susceptible isolates.