Blood and intra-abdominal <i>Candida</i> spp. from a multicentre study conducted in Madrid using EUCAST: emergence of fluconazole resistance in <i>Candida parapsilosis</i>, low echinocandin resistance and absence of <i>Candida auris</i>
Judith Díaz-García, Ana Gómez, Marina Machado, Luís Alcalá, Elena Reigadas, Carlos Sánchez‐Carrillo, Ana Pérez‐Ayala, Elia Gómez‐García de la Pedrosa, Fernando González‐Romo, María Soledad Cuétara, Coral García-Esteban, Inmaculada Quiles‐Melero, Nelly Daniela Zurita, María Muñoz‐Algarra, María Teresa Durán-Valle, Aída Sánchez‐García, Patricia Muñóz, Pilar Escribano, Jesús Guinea, the CANDIMAD Study Group, Judith Díaz-García, Aína Mesquida, Ana Gómez, Marina Machado, Luis Alcalá, Elena Reigadas, Carlos Sánchez‐Carrillo, Patricia Muñoz, Pilar Escribano, Jesús Guinea, Ana Pérez‐Ayala, Rosaura Pérez Muñoz, María del Carmen Vera González, Elia Gómez-García De La Pedrosa, Fernando González Romo, Paloma Merino Amador, María Soledad Cuétara, Oscar Manuel Muñoz Clemente, Víctor Antón Berenguer, Aída Sánchez-García, Coral García-Esteban, Oscar Cuevas Lobato, Guadalupe Bernal, Nelly Daniela Zurita, Ainhoa Gutiérrez Cobos, María Muñoz‐Algarra, Isabel Sánchez Romero, Inmaculada Quiles-Melero, Florinda San Juan Delgado, María Teresa Durán-Valle, Yolanda Romero, Arturo Manuel Fraile Torres
Abstract
OBJECTIVES: We prospectively monitored the epidemiology and antifungal susceptibility of Candida spp. from blood cultures and intra-abdominal samples in patients admitted to hospitals in the Madrid area. METHODS: Between 2019 and 2021, we prospectively collected incident isolates [one per species, patient and compartment (blood cultures versus intra-abdominal samples)] from patients admitted to any of 16 hospitals located in Madrid. We studied the antifungal susceptibilities to amphotericin B, triazoles, micafungin, anidulafungin and ibrexafungerp following the EUCAST E.Def 7.3.2 procedure. RESULTS: A total of 2107 Candida spp. isolates (1895 patients) from blood cultures (51.7%) and intra-abdominal samples were collected. Candida albicans, the Candida glabrata complex, the Candida parapsilosis complex, Candida tropicalis and Candida krusei accounted for 96.9% of the isolates; in contrast, Candida auris was undetected. Fluconazole resistance in Candida spp. was higher in blood cultures than in intra-abdominal samples (9.1% versus 8.2%; P > 0.05), especially for the C. parapsilosis complex (16.6% versus 3.6%, P < 0.05), whereas echinocandin resistance tended to be lower in blood cultures (0.5% versus 1.0%; P > 0.05). Resistance rates have risen, particularly for fluconazole in blood culture isolates, which increased sharply in 2021. Ibrexafungerp showed in vitro activity against most isolates. Species distributions and resistance rates varied among hospitals. CONCLUSIONS: Whereas no C. auris isolates were detected, fluconazole-resistant C. parapsilosis isolates have been spreading across the region and this has pulled up the rate of fluconazole resistance. In contrast, the rate of echinocandin resistance continues to be low.