First Report of Candidemia Clonal Outbreak Caused by Emerging Fluconazole-Resistant Candida parapsilosis Isolates Harboring Y132F and/or Y132F+K143R in Turkey

Amir Arastehfar; Farnaz Daneshnia; Suleyha Hilmioğlu-Polat; Wenjie Fang; Melike Yaşar; Furkan Polat; Dilek Yeşim Metin; Petra Rigole; Tom Coenye; Macit Ilkit; Weihua Pan; Wanqing Liao; Ferry Hagen; Markus Kostrzewa; David S Perlin; Cornelia Lass-Flörl; Teun Boekhout

doi:10.1128/AAC.01001-20

First Report of Candidemia Clonal Outbreak Caused by Emerging Fluconazole-Resistant Candida parapsilosis Isolates Harboring Y132F and/or Y132F+K143R in Turkey

Amir Arastehfar, Farnaz Daneshnia, Suleyha Hilmioğlu-Polat, Wenjie Fang, Melike Yaşar, Furkan Polat, Dilek Yeşim Metin, Petra Rigole, Tom Coenye, Macit Ilkit, Weihua Pan, Wanqing Liao, Ferry Hagen, Markus Kostrzewa, David S Perlin, Cornelia Lass-Flörl, Teun Boekhout

Research output: Contribution to journal/periodical › Article › Scientific › peer-review

64 Citations (Scopus)

Abstract

Clonal outbreaks of fluconazole-resistant (FLZR) Candida parapsilosis isolates have been reported in several countries. Despite its being the second leading cause of candidemia, the azole resistance mechanisms and the clonal expansion of FLZR C. parapsilosis blood isolates have not been reported in Turkey. In this study, we consecutively collected C. parapsilosis blood isolates (n = 225) from the fifth largest hospital in Turkey (2007 to 2019), assessed their azole susceptibility pattern using CLSI M27-A3/S4, and sequenced ERG11 for all and MRR1, TAC1, and UPC2 for a selected number of C. parapsilosis isolates. The typing resolution of two widely used techniques, amplified fragment length polymorphism typing (AFLP) and microsatellite typing (MST), and the biofilm production of FLZR isolates with and without Y132F were compared. Approximately 27% of isolates were FLZR (60/225), among which 90% (54/60) harbored known mutations in Erg11, including Y132F (24/60) and Y132F+K143R (19/60). Several mutations specific to FLZR isolates were found in MRR1, TAC1, and UPC2 AFLP grouped isolates into two clusters, while MST revealed several clusters. The majority of Y132F/Y132F+K143R isolates grouped in clonal clusters, which significantly expanded throughout 2007 to 2019 in neonatal wards. Candida parapsilosis isolates carrying Y132F were associated with significantly higher mortality and less biofilm production than other FLZR isolates. Collectively, we documented the first outbreak of FLZR C. parapsilosis blood isolates in Turkey. The MRR1, TAC1, and UPC2 mutations exclusively found in FLZR isolates establishes a basis for future studies, which will potentially broaden our knowledge of FLZR mechanisms in C. parapsilosis MST should be a preferred method for clonal analysis of C. parapsilosis isolates in outbreak scenarios.

Original language	English
Journal	Antimicrobial Agents and Chemotherapy
Volume	64
Issue number	10
DOIs	https://doi.org/10.1128/AAC.01001-20
Publication status	Published - 21 Sept 2020

Access to Document

10.1128/AAC.01001-20

Cite this

Arastehfar, A., Daneshnia, F., Hilmioğlu-Polat, S., Fang, W., Yaşar, M., Polat, F., Metin, D. Y., Rigole, P., Coenye, T., Ilkit, M., Pan, W., Liao, W., Hagen, F., Kostrzewa, M., Perlin, D. S., Lass-Flörl, C., & Boekhout, T. (2020). First Report of Candidemia Clonal Outbreak Caused by Emerging Fluconazole-Resistant Candida parapsilosis Isolates Harboring Y132F and/or Y132F+K143R in Turkey. Antimicrobial Agents and Chemotherapy, 64(10). https://doi.org/10.1128/AAC.01001-20

@article{f67fa32a64c34d5092558ef8e6d48871,

title = "First Report of Candidemia Clonal Outbreak Caused by Emerging Fluconazole-Resistant Candida parapsilosis Isolates Harboring Y132F and/or Y132F+K143R in Turkey",

abstract = "Clonal outbreaks of fluconazole-resistant (FLZR) Candida parapsilosis isolates have been reported in several countries. Despite its being the second leading cause of candidemia, the azole resistance mechanisms and the clonal expansion of FLZR C. parapsilosis blood isolates have not been reported in Turkey. In this study, we consecutively collected C. parapsilosis blood isolates (n = 225) from the fifth largest hospital in Turkey (2007 to 2019), assessed their azole susceptibility pattern using CLSI M27-A3/S4, and sequenced ERG11 for all and MRR1, TAC1, and UPC2 for a selected number of C. parapsilosis isolates. The typing resolution of two widely used techniques, amplified fragment length polymorphism typing (AFLP) and microsatellite typing (MST), and the biofilm production of FLZR isolates with and without Y132F were compared. Approximately 27% of isolates were FLZR (60/225), among which 90% (54/60) harbored known mutations in Erg11, including Y132F (24/60) and Y132F+K143R (19/60). Several mutations specific to FLZR isolates were found in MRR1, TAC1, and UPC2 AFLP grouped isolates into two clusters, while MST revealed several clusters. The majority of Y132F/Y132F+K143R isolates grouped in clonal clusters, which significantly expanded throughout 2007 to 2019 in neonatal wards. Candida parapsilosis isolates carrying Y132F were associated with significantly higher mortality and less biofilm production than other FLZR isolates. Collectively, we documented the first outbreak of FLZR C. parapsilosis blood isolates in Turkey. The MRR1, TAC1, and UPC2 mutations exclusively found in FLZR isolates establishes a basis for future studies, which will potentially broaden our knowledge of FLZR mechanisms in C. parapsilosis MST should be a preferred method for clonal analysis of C. parapsilosis isolates in outbreak scenarios.",

author = "Amir Arastehfar and Farnaz Daneshnia and Suleyha Hilmioğlu-Polat and Wenjie Fang and Melike Ya{\c s}ar and Furkan Polat and Metin, {Dilek Ye{\c s}im} and Petra Rigole and Tom Coenye and Macit Ilkit and Weihua Pan and Wanqing Liao and Ferry Hagen and Markus Kostrzewa and Perlin, {David S} and Cornelia Lass-Fl{\"o}rl and Teun Boekhout",

note = "Copyright {\textcopyright} 2020 American Society for Microbiology.",

year = "2020",

month = sep,

day = "21",

doi = "10.1128/AAC.01001-20",

language = "English",

volume = "64",

journal = "Antimicrobial Agents and Chemotherapy",

issn = "0066-4804",

publisher = "American Society for Microbiology",

number = "10",

}

Arastehfar, A, Daneshnia, F, Hilmioğlu-Polat, S, Fang, W, Yaşar, M, Polat, F, Metin, DY, Rigole, P, Coenye, T, Ilkit, M, Pan, W, Liao, W, Hagen, F, Kostrzewa, M, Perlin, DS, Lass-Flörl, C & Boekhout, T 2020, 'First Report of Candidemia Clonal Outbreak Caused by Emerging Fluconazole-Resistant Candida parapsilosis Isolates Harboring Y132F and/or Y132F+K143R in Turkey', Antimicrobial Agents and Chemotherapy, vol. 64, no. 10. https://doi.org/10.1128/AAC.01001-20

First Report of Candidemia Clonal Outbreak Caused by Emerging Fluconazole-Resistant Candida parapsilosis Isolates Harboring Y132F and/or Y132F+K143R in Turkey. / Arastehfar, Amir; Daneshnia, Farnaz; Hilmioğlu-Polat, Suleyha et al.
In: Antimicrobial Agents and Chemotherapy, Vol. 64, No. 10, 21.09.2020.

Research output: Contribution to journal/periodical › Article › Scientific › peer-review

TY - JOUR

T1 - First Report of Candidemia Clonal Outbreak Caused by Emerging Fluconazole-Resistant Candida parapsilosis Isolates Harboring Y132F and/or Y132F+K143R in Turkey

AU - Arastehfar, Amir

AU - Daneshnia, Farnaz

AU - Hilmioğlu-Polat, Suleyha

AU - Fang, Wenjie

AU - Yaşar, Melike

AU - Polat, Furkan

AU - Metin, Dilek Yeşim

AU - Rigole, Petra

AU - Coenye, Tom

AU - Ilkit, Macit

AU - Pan, Weihua

AU - Liao, Wanqing

AU - Hagen, Ferry

AU - Kostrzewa, Markus

AU - Perlin, David S

AU - Lass-Flörl, Cornelia

AU - Boekhout, Teun

PY - 2020/9/21

Y1 - 2020/9/21

N2 - Clonal outbreaks of fluconazole-resistant (FLZR) Candida parapsilosis isolates have been reported in several countries. Despite its being the second leading cause of candidemia, the azole resistance mechanisms and the clonal expansion of FLZR C. parapsilosis blood isolates have not been reported in Turkey. In this study, we consecutively collected C. parapsilosis blood isolates (n = 225) from the fifth largest hospital in Turkey (2007 to 2019), assessed their azole susceptibility pattern using CLSI M27-A3/S4, and sequenced ERG11 for all and MRR1, TAC1, and UPC2 for a selected number of C. parapsilosis isolates. The typing resolution of two widely used techniques, amplified fragment length polymorphism typing (AFLP) and microsatellite typing (MST), and the biofilm production of FLZR isolates with and without Y132F were compared. Approximately 27% of isolates were FLZR (60/225), among which 90% (54/60) harbored known mutations in Erg11, including Y132F (24/60) and Y132F+K143R (19/60). Several mutations specific to FLZR isolates were found in MRR1, TAC1, and UPC2 AFLP grouped isolates into two clusters, while MST revealed several clusters. The majority of Y132F/Y132F+K143R isolates grouped in clonal clusters, which significantly expanded throughout 2007 to 2019 in neonatal wards. Candida parapsilosis isolates carrying Y132F were associated with significantly higher mortality and less biofilm production than other FLZR isolates. Collectively, we documented the first outbreak of FLZR C. parapsilosis blood isolates in Turkey. The MRR1, TAC1, and UPC2 mutations exclusively found in FLZR isolates establishes a basis for future studies, which will potentially broaden our knowledge of FLZR mechanisms in C. parapsilosis MST should be a preferred method for clonal analysis of C. parapsilosis isolates in outbreak scenarios.

AB - Clonal outbreaks of fluconazole-resistant (FLZR) Candida parapsilosis isolates have been reported in several countries. Despite its being the second leading cause of candidemia, the azole resistance mechanisms and the clonal expansion of FLZR C. parapsilosis blood isolates have not been reported in Turkey. In this study, we consecutively collected C. parapsilosis blood isolates (n = 225) from the fifth largest hospital in Turkey (2007 to 2019), assessed their azole susceptibility pattern using CLSI M27-A3/S4, and sequenced ERG11 for all and MRR1, TAC1, and UPC2 for a selected number of C. parapsilosis isolates. The typing resolution of two widely used techniques, amplified fragment length polymorphism typing (AFLP) and microsatellite typing (MST), and the biofilm production of FLZR isolates with and without Y132F were compared. Approximately 27% of isolates were FLZR (60/225), among which 90% (54/60) harbored known mutations in Erg11, including Y132F (24/60) and Y132F+K143R (19/60). Several mutations specific to FLZR isolates were found in MRR1, TAC1, and UPC2 AFLP grouped isolates into two clusters, while MST revealed several clusters. The majority of Y132F/Y132F+K143R isolates grouped in clonal clusters, which significantly expanded throughout 2007 to 2019 in neonatal wards. Candida parapsilosis isolates carrying Y132F were associated with significantly higher mortality and less biofilm production than other FLZR isolates. Collectively, we documented the first outbreak of FLZR C. parapsilosis blood isolates in Turkey. The MRR1, TAC1, and UPC2 mutations exclusively found in FLZR isolates establishes a basis for future studies, which will potentially broaden our knowledge of FLZR mechanisms in C. parapsilosis MST should be a preferred method for clonal analysis of C. parapsilosis isolates in outbreak scenarios.

U2 - 10.1128/AAC.01001-20

DO - 10.1128/AAC.01001-20

M3 - Article

C2 - 32690638

SN - 0066-4804

VL - 64

JO - Antimicrobial Agents and Chemotherapy

JF - Antimicrobial Agents and Chemotherapy

IS - 10

ER -

First Report of Candidemia Clonal Outbreak Caused by Emerging Fluconazole-Resistant Candida parapsilosis Isolates Harboring Y132F and/or Y132F+K143R in Turkey

Abstract

Access to Document

Fingerprint

Cite this