AUTHOR=Guinea Jesús , Arendrup Maiken C. , Cantón Rafael , Cantón Emilia , García-Rodríguez Julio , Gómez Ana , de la Pedrosa Elia Gómez G. , Hare Rasmus K. , Orden Beatriz , Sanguinetti Maurizio , Pemán Javier , Posteraro Brunella , Ruiz-Gaitán Alba , Parisi Gabriella , Da Matta Daniel Archimedes , Colombo Arnaldo L. , Sánchez-Carrillo Carlos , Reigadas Elena , Muñoz Patricia , Escribano Pilar 

TITLE=Genotyping Reveals High Clonal Diversity and Widespread Genotypes of Candida Causing Candidemia at Distant Geographical Areas

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=10

YEAR=2020

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2020.00166

DOI=10.3389/fcimb.2020.00166

ISSN=2235-2988

ABSTRACT=<p>The objectives of this study were to gain further insight on <italic>Candida</italic> genotype distribution and percentage of clustered isolates between hospitals and to identify potential clusters involving different hospitals and cities. We aim to genotype <italic>Candida</italic> spp. isolates causing candidemia in patients admitted to 16 hospitals in Spain, Italy, Denmark, and Brazil. Eight hundred and eighty-four isolates (<italic>Candida albicans, n</italic> = 534; <italic>C. parapsilosis, n</italic> = 282; and <italic>C. tropicalis, n</italic> = 68) were genotyped using species-specific microsatellite markers. CDC3, EF3, HIS3, CAI, CAIII, and CAVI were used for <italic>C. albicans</italic>, Ctrm1, Ctrm10, Ctrm12, Ctrm21, Ctrm24, and Ctrm28 for <italic>C. tropicalis</italic>, and CP1, CP4a, CP6, and B for <italic>C. parapsilosis</italic>. Genotypes were classified as singletons (genotype only found once) or clusters (same genotype infecting two or more patients). Clusters were defined as intra-hospital (involving patients admitted to a single hospital), intra-ward (involving patients admitted to the same hospital ward) or widespread (involving patients admitted to different hospitals). The percentage of clusters and the proportion of patients involved in clusters among species, genotypic diversity and distribution of genetic diversity were assessed. Seven hundred and twenty-three genotypes were detected, 78 (11%) being clusters, most of which (57.7%; <italic>n</italic> = 45/78) were intra-hospital clusters including intra-ward ones (42.2%; <italic>n</italic> = 19/45). The proportion of clusters was not statistically different between species, but the percentage of patients in clusters varied among hospitals.</p><p>A number of genotypes (7.2%; 52/723) were widespread (found at different hospitals), comprising 66.7% (52/78) of clusters, and involved patients at hospitals in the same city (<italic>n</italic> = 21) or in different cities (<italic>n</italic> = 31). Only one <italic>C. parapsilosis</italic> cluster was a widespread genotype found in all four countries. Around 11% of <italic>C. albicans</italic> and <italic>C. parapsilosis</italic> isolates causing candidemia are clusters that may result from patient-to-patient transmission, widespread genotypes commonly found in unrelated patients, or insufficient microsatellite typing genetic discrimination.</p>