AUTHOR=Arastehfar Amir , Daneshnia Farnaz , Najafzadeh Mohammad Javad , Hagen Ferry , Mahmoudi Shahram , Salehi Mohammadreza , Zarrinfar Hossein , Namvar Zahra , Zareshahrabadi Zahra , Khodavaisy Sadegh , Zomorodian Kamiar , Pan Weihua , Theelen Bart , Kostrzewa Markus , Boekhout Teun , Lass-Flörl Cornelia 

TITLE=Evaluation of Molecular Epidemiology, Clinical Characteristics, Antifungal Susceptibility Profiles, and Molecular Mechanisms of Antifungal Resistance of Iranian Candida parapsilosis Species Complex Blood Isolates

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.2020.00206

DOI=10.3389/fcimb.2020.00206

ISSN=2235-2988

ABSTRACT=<p>Clonal expansion of fluconazole resistant (FLZ-R) <italic>Candida parapsilosis</italic> isolates is increasingly being identified in many countries, while there is no study exploring the antifungal susceptibility pattern, genetic diversity, and clinical information for Iranian <italic>C. parapsilosis</italic> blood isolates. <italic>Candida parapsilosis</italic> species complex blood isolates (<italic>n</italic> = 98) were recovered from nine hospitals located in three major cities, identified by MALDI-TOF MS, and their genetic relatedness was examined by AFLP fingerprinting. Antifungal susceptibility testing followed CLSI-M27-A3 and <italic>ERG11, MRR1</italic> and hotspots 1/2 (HS1/2) of <italic>FKS1</italic> were sequenced to assess the azole and echinocandin resistance mechanisms, respectively. Ninety-four <italic>C. parapsilosis</italic> and four <italic>Candida orthopsilosis</italic> isolates were identified from 90 patients. Only 43 patients received systemic antifungal drugs with fluconazole as the main antifungal used. The overall mortality rate was 46.6% (42/90) and death mostly occurred for those receiving systemic antifungals (25/43) relative to those not treated (17/47). Although, antifungal-resistance was rare, one isolate was multidrug-resistant (FLZ = 16 μg/ml and micafungin = 8 μg/ml) and the infected patient showed therapeutic failure to FLZ prophylaxis. Mutations causing azole and echinocandin resistance were not found in the genes studied. AFLP revealed five genotypes (G) and G1 was the main one (59/94; 62.7%). Clinical outcome was significantly associated with city (<italic>P</italic> = 0.02, α &lt;0.05) and Mashhad was significantly associated with mortality (<italic>P</italic> = 0.03, α &lt;0.05). Overall, we found a low level of antifungal resistance for Iranian <italic>C. parapsilosis</italic> blood isolates, but the noted MDR strain can potentially become the source of future infections and challenge the antifungal therapy in antifungal-naïve patients. AFLP typing results warrants confirmation using other resolutive typing methods.</p>