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. 2022 Nov 21;8(11):1228.
doi: 10.3390/jof8111228.

Candida Genotyping of Blood Culture Isolates from Patients Admitted to 16 Hospitals in Madrid: Genotype Spreading during the COVID-19 Pandemic Driven by Fluconazole-Resistant C. parapsilosis

Judith Díaz-García  1   2 , Ana Gómez  1   2 , Marina Machado  1   2 , Luis Alcalá  1   2   3 , Elena Reigadas  1   2   3 , Carlos Sánchez-Carrillo  1   2   3 , Ana Pérez-Ayala  4   5 , Elia Gómez-García de la Pedrosa  6   7   8 , Fernando González-Romo  9   10 , María Soledad Cuétara  11 , Coral García-Esteban  12 , Inmaculada Quiles-Melero  13 , Nelly Daniela Zurita  14 , María Muñoz Algarra  15 , María Teresa Durán-Valle  16 , Aída Sánchez-García  17 , Patricia Muñoz  1   2   3   18 , Pilar Escribano  1   2 , Jesús Guinea  1   2   3 , On Behalf Of The Candimad Study Group
Affiliations

Candida Genotyping of Blood Culture Isolates from Patients Admitted to 16 Hospitals in Madrid: Genotype Spreading during the COVID-19 Pandemic Driven by Fluconazole-Resistant C. parapsilosis

Judith Díaz-García et al. J Fungi (Basel). .

Erratum in

Abstract

Background: Candidaemia and invasive candidiasis are typically hospital-acquired. Genotyping isolates from patients admitted to different hospitals may be helpful in tracking clones spreading across hospitals, especially those showing antifungal resistance.

Methods: We characterized Candida clusters by studying Candida isolates (C. albicans, n = 1041; C. parapsilosis, n = 354, and C. tropicalis, n = 125) from blood cultures (53.8%) and intra-abdominal samples (46.2%) collected as part of the CANDIMAD (Candida in Madrid) study in Madrid (2019-2021). Species-specific microsatellite markers were used to define the genotypes of Candida spp. found in a single patient (singleton) or several patients (cluster) from a single hospital (intra-hospital cluster) or different hospitals (widespread cluster).

Results: We found 83 clusters, of which 20 were intra-hospital, 49 were widespread, and 14 were intra-hospital and widespread. Some intra-hospital clusters were first detected before the onset of the COVID-19 pandemic, but the number of clusters increased during the pandemic, especially for C. parapsilosis. The proportion of widespread clusters was significantly higher for genotypes found in both compartments than those exclusively found in either the blood cultures or intra-abdominal samples. Most C. albicans- and C. tropicalis-resistant genotypes were singleton and presented exclusively in either blood cultures or intra-abdominal samples. Fluconazole-resistant C. parapsilosis isolates belonged to intra-hospital clusters harboring either the Y132F or G458S ERG11p substitutions; the dominant genotype was also widespread.

Conclusions: the number of clusters-and patients involved-increased during the COVID-19 pandemic mainly due to the emergence of fluconazole-resistant C. parapsilosis genotypes.

Keywords: COVID-19; Candida; Madrid; blood culture; candidaemia; intra-abdominal samples; microsatellite genotyping.

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Conflict of interest statement

J.G. has received funds for participating in educational activities organized on behalf of Gilead, Pfizer, Mundipharma, and MSD; he has also received research funds from FIS, Gilead, Scynexis, F2G, Mundipharma, and Cidara, outside the submitted work.

Figures

Figure 1
Figure 1
Timeline of C. albicans (green shades), C. parapsilosis (red shades), and C. tropicalis (blue shades) intra-hospital clusters found in blood cultures during the study period (2019–2021). Genotype codes in bold indicate those that were also widespread clusters. Cells in dark colours with numbers indicate the date the genotype was detected in a given patient within each cluster; cells in light shades indicate the latency period (time period spanning two time points in which isolates in a cluster were detected) of the cluster in the hospital. Cells in dark red indicate fluconazole-resistant C. parapsilosis genotypes. Dotted cell columns represent the onset of each COVID-19 wave.
Figure 2
Figure 2
Numbers (and percentage) of patients involved in singleton and intra-hospital clusters per species over the study period. * Differences reaching statistical significance (p < 0.05).
Figure 3
Figure 3
Minimum spanning tree showing widespread C. albicans clusters found in blood cultures shown per hospital of source (a) or combined with intra-abdominal samples (b). Circles represent different genotypes and circle size the number of isolates belonging to the same genotype. Connecting lines between circles show profile similarities. The solid bold line indicates differences in only 1 marker, solid line indicates differences in 2 markers, dashed line indicates differences in 3 markers, and dotted line indicates differences in 4 or more markers. CA-056 and CA-313 were resistant genotypes. Grey circles depict previously reported clonal complexes 2 to 5. Black circles depict clonal complex 6–12, newly reported herein.
Figure 4
Figure 4
Minimum spanning tree showing C. parapsilosis widespread clusters found in blood cultures shown per hospital of source (a) or combined with intra-abdominal samples (b). Circles represent different genotypes and circle size the number of isolates belonging to the same genotype. Connecting lines between circles show profile similarities. The solid bold line indicates differences in only 1 marker, solid line indicates differences in 2 markers, dashed line indicates differences in 3 markers, and dotted line indicates differences in 4 or more markers. CP-451 is a resistant genotype. The grey circle depicts the previously reported clonal complex 2. Black circles depict clonal complexes 3 and 4, newly reported herein. * Genotype CP-023.
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