背景:氟康唑耐药的近平滑念珠菌是一个值得关注的问题。
目的:描述在西班牙和罗马的医院中流行的氟康唑耐药拟态梭菌基因型,并研究其与ERG11p替换相关的唑耐药谱。
方法:我们从西班牙五个城市和罗马的13家医院收治的患者中选择了氟康唑耐药梭菌(2019年至2023年,n=528;根据EUCAST,MIC≥8mg/L)。此外,我们测试了伏立康唑,泊沙康唑,伊沙武康唑,两性霉素B,米卡芬净,anidulafungin和ibrexafungerp易感性。
结果:在发现的53个基因型中,49拥有Y132F替代品,其中五个主要是城市特异性基因型,涉及几乎一半的分离株。另一种基因型涉及具有G458S替代的分离株。最后,我们发现了两种具有野生型ERG11基因序列的基因型和一种具有R398I替换的基因型。所有分离株对两性霉素B完全敏感/野生型,Anidulafungin,米卡芬净和ibrexafungerp.发现的唑类耐药模式是:伏立康唑耐药(74.1%)或伏立康唑中间体(25.2%),泊沙康唑耐药(10%)和异乌康唑非野生型(47.5%)。如果泊沙康唑是野生型,则氟康唑耐药和伏立康唑非野生型分离株可能具有替代Y132F;但是,如果泊沙康唑是非野生型,如果异乌康唑MIC>0.125mg/L,则表示取代G458S,如果异乌康唑MIC≤0.125mg/L,则表示取代Y132F。
结论:我们检测到最近在西班牙一些城市克隆性传播的氟康唑耐药梭菌,主要是由城市特有的基因型驱动,其中涉及大量具有Y132FERG11p替代的分离株。可能怀疑具有替代Y132F的分离株,因为它们对伏立康唑不敏感,很少对泊沙康唑耐药。
BACKGROUND: Fluconazole-resistant Candida parapsilosis is a matter of concern.
OBJECTIVE: To describe fluconazole-resistant C. parapsilosis genotypes circulating across hospitals in Spain and Rome and to study their azole-resistance profile associated with ERG11p substitutions.
METHODS: We selected fluconazole-resistant C. parapsilosis isolates (n = 528 from 2019 to 2023; MIC ≥8 mg/L according to EUCAST) from patients admitted to 13 hospitals located in five Spanish cities and Rome. Additionally, we tested voriconazole, posaconazole, isavuconazole, amphotericin B, micafungin, anidulafungin and ibrexafungerp susceptibility.
RESULTS: Of the 53 genotypes found, 49 harboured the Y132F substitution, five of which were dominating city-specific genotypes involving almost half the isolates. Another genotype involved isolates harbouring the G458S substitution. Finally, we found two genotypes with the wild-type ERG11 gene sequence and one with the R398I substitution. All isolates were fully susceptible/wild-type to amphotericin B, anidulafungin, micafungin and ibrexafungerp. The azole-resistance patterns found were: voriconazole-resistant (74.1%) or voriconazole-intermediate (25.2%), posaconazole-resistant (10%) and isavuconazole non-wild-type (47.5%). Fluconazole-resistant and voriconazole non-wild-type isolates were likely to harbour substitution Y132F if posaconazole was wild type; however, if posaconazole was non-wild type, substitution G458S was indicated if isavuconazole MIC was >0.125 mg/L or substitution Y132F if isavuconazole MIC was ≤0.125 mg/L.
CONCLUSIONS: We detected a recent clonal spread of fluconazole-resistant C. parapsilosis across some cities in Spain, mostly driven by dominating city-specific genotypes, which involved a large number of isolates harbouring the Y132F ERG11p substitution. Isolates harbouring substitution Y132F can be suspected because they are non-susceptible to voriconazole and rarely posaconazole-resistant.