Trends in antifungal resistance in <i>Candida</i> from a multicenter study conducted in Madrid (CANDIMAD study): fluconazole-resistant <i>C. parapsilosis</i> spreading has gained traction in 2022
Judith Díaz-García, Marina Machado, Luís Alcalá, Elena Reigadas, 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, on behalf of the CANDIMAD study group, Judith Díaz-García, Aína Mesquida, Ana Gómez, Marina Machado, Luís Alcalá, Elena Reigadas, Carlos Sánchez‐Carrillo, Patricia Muñóz, 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, Aída Sánchez‐García, Coral García-Esteban, Óscar Cuevas, 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 Gil-Romero, Arturo Manuel Fraile Torres
Abstract
ABSTRACT We previously conducted a multicenter surveillance study on Candida epidemiology and antifungal resistance in Madrid (CANDIMAD study; 2019–2021), detecting an increase in fluconazole-resistant Candida parapsilosis . We here present data on isolates collected in 2022. Furthermore, we report the epidemiology and antifungal resistance trends during the entire period, including an analysis per ward of admission. Candida spp. incident isolates from blood cultures and intra-abdominal samples from patients cared for at 16 hospitals in Madrid, Spain, were tested with the EUCAST E.Def 7.3.2 method against amphotericin B, azoles, micafungin, anidulafungin, and ibrexafungerp and were molecularly characterized. In 2022, we collected 766 Candida sp. isolates (686 patients; blood cultures, 48.8%). Candida albicans was the most common species found, and Candida auris was undetected. No resistance to amphotericin B was found. Overall, resistance to echinocandins was low (0.7%), whereas fluconazole resistance was 12.0%, being higher in blood cultures (16.0%) mainly due to fluconazole-resistant C. parapsilosis clones harboring the Y132F-R398I ERG11p substitutions. Ibrexafungerp showed in vitro activity against the isolates tested. Whereas C. albicans was the dominant species in most hospital wards, we observed increasing C. parapsilosis proportions in blood. During the entire period, echinocandin resistance rates remained steadily low, while fluconazole resistance increased in blood from 6.8% (2019) to 16% (2022), mainly due to fluconazole-resistant C. parapsilosis (2.6% in 2019 to 36.6% in 2022). Up to 7 out of 16 hospitals were affected by fluconazole-resistant C. parapsilosis . In conclusion, rampant clonal spreading of C. parapsilosis fluconazole-resistant genotypes is taking place in Madrid.