New microbes and new infections · 2026
Incidence of azole resistance among clinical isolates of Candida parapsilosis: Results from the French nationwide multicenter prospective study "ReCap" 2022-2024.
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Fekkar Arnaud, Blaize Marion, Cassaing Sophie, Sendid Boualem, Pasquier Grégoire, Imbert Sébastien, Hennequin Christophe, Botterel Françoise, Morio Florent, Menotti Jean, Le Gal Solène, Bailly Eloise, Bougnoux Marie-Elisabeth, Huguenin Antoine, Bonnal Christine, Sasso Milène, Feuss Aliosha, Jabet Arnaud, Godmer Alexandre, Piarroux Renaud, Normand Anne-Cécile
Аннотация
BACKGROUND: Fluconazole-resistant isolates of Candida parapsilosis have emerged worldwide in recent years.
OBJECTIVE: Our objectives were to get an overview of the French epidemiology, to determine the incidence of azole resistance and to assess the genetic relationship between isolates.
METHODS: We initiated a prospective national multicenter study (ReCap - Resistance of Candida parapsilosis to azole drugs). All C. parapsilosis isolates routinely identified in 15 French hospital mycology laboratories were included over a period of 6 to 20 months (depending on the center), regardless of the type of specimen and hospitalization unit. Isolates were tested for fluconazole susceptibility using a gradient diffusion method. Non-susceptible isolates (MIC ≥4 mg/L) and a random selection of susceptible isolates were subjected to further analysis (MICs determination by EUCAST method and microsatellite genotyping).
RESULTS: Between May 2022 and February 2024, a total of 2,602 isolates were collected from 1,830 patients. Among these, 392 isolates (15.1%) from 184 patients (10%) were found to be resistant (MIC >4 mg/L). Percentage of patients colonized or infected by a resistant isolate ranged from 0 to 54.4% across centers. Genotyping analysis performed on 1,320 isolates showed high diversity among susceptible isolates and indicated that two fluconazole-resistant clusters are circulating in different hospitals of the Paris area. Cross-resistance occurred frequently with voriconazole resistance observed in 62.9% (73/116) of fluconazole-resistant isolates.
CONCLUSION: In France, the frequency of resistance to fluconazole reaches 10% of patients harboring C. parapsilosis, with very significant differences between regions. The Paris area is affected by two epidemic clusters involving many patients.
OBJECTIVE: Our objectives were to get an overview of the French epidemiology, to determine the incidence of azole resistance and to assess the genetic relationship between isolates.
METHODS: We initiated a prospective national multicenter study (ReCap - Resistance of Candida parapsilosis to azole drugs). All C. parapsilosis isolates routinely identified in 15 French hospital mycology laboratories were included over a period of 6 to 20 months (depending on the center), regardless of the type of specimen and hospitalization unit. Isolates were tested for fluconazole susceptibility using a gradient diffusion method. Non-susceptible isolates (MIC ≥4 mg/L) and a random selection of susceptible isolates were subjected to further analysis (MICs determination by EUCAST method and microsatellite genotyping).
RESULTS: Between May 2022 and February 2024, a total of 2,602 isolates were collected from 1,830 patients. Among these, 392 isolates (15.1%) from 184 patients (10%) were found to be resistant (MIC >4 mg/L). Percentage of patients colonized or infected by a resistant isolate ranged from 0 to 54.4% across centers. Genotyping analysis performed on 1,320 isolates showed high diversity among susceptible isolates and indicated that two fluconazole-resistant clusters are circulating in different hospitals of the Paris area. Cross-resistance occurred frequently with voriconazole resistance observed in 62.9% (73/116) of fluconazole-resistant isolates.
CONCLUSION: In France, the frequency of resistance to fluconazole reaches 10% of patients harboring C. parapsilosis, with very significant differences between regions. The Paris area is affected by two epidemic clusters involving many patients.