Production and optimization of novel Sphorolipids from Candida parapsilosis grown on potato peel and frying oil wastes and their adverse effect on Mucorales fungal strains.

BRIEF INTRODUCTION: Mucormycosis disease, which has recently expanded with the Covid 19 pandemic in many countries, endangers patients' lives, and treatment with common drugs is fraught with unfavorable side effects. AIM AND OBJECTIVES: This study deals with the economic production of sophorolipids (SLs) from different eight fungal isolates strains utilizing potato peels waste (PPW) and frying oil waste (FOW). Then investigate their effect against mucormycetes fungi. RESULTS: The screening of the isolates for SLs production revealed the highest yield (39 g/100 g substrate) with most efficiency was related to a yeast that have been identified genetically as Candida parapsilosis. Moreover, the characterizations studies of the produced SLs by FTIR, 1H NMR and LC-MS/MS proved the existence of both acidic and lactonic forms, while their surface activity was confirmed by the surface tension (ST) assessment. The SLs production was optimized utilizing Box-Behnken design resulting in the amelioration of yield by 30% (55.3 g/100 g substrate) and ST by 20.8% (38mN/m) with constant level of the critical micelle concentration (CMC) at 125 mg/L. The studies also revealed the high affinity toward soybean oil (E24 = 50%), in addition to maintaining the emulsions stability against broad range of pH (4-10) and temperature (10-100℃). Furthermore, the antifungal activity against Mucor racemosus, Rhizopus microsporus, and Syncephalastrum racemosum proved a high inhibition efficiency of the produced SLs. CONCLUSION: The findings demonstrated the potential application of the SLs produced economically from agricultural waste as an effective and safer alternative for the treatment of infection caused by black fungus.

Hospital Clonal Outbreak of Fluconazole-Resistant Candida parapsilosis Harboring the Y132F ERG11p Substitution in a French Intensive Care Unit.

We report the first identification of a fluconazole-resistant Candida parapsilosis (FR-Cp) strain in our hospital, which subsequently caused an outbreak involving 17 patients (12 deaths) within a 26-bed French intensive care unit. Microsatellite genotyping confirmed that all FR-Cp isolates belonged to the same clone. Given recent reports of rapid dissemination of these emerging clones, routine testing of azole susceptibility for all Candida parapsilosis isolates should be encouraged, at least in ICU patients.

Candida parapsilosis infection after double-lung transplantation in a patient with pulmonary fibrosis caused by COVID-19.

Pulmonary fibrosis is a complication in patients with coronavirus disease 2019 (COVID-19). Extensive pulmonary fibrosis is a severe threat to patients' life and lung transplantation is last resort to prolong the life of patients. We reported a case of critical type COVID-19 patient, though various treatment measures were used, including anti-virus, anti-infection, improving immunity, convalescent plasma, prone position ventilation, and airway cleaning by fiber-optic bronchoscope, although his COVID-19 nucleic acid test turned negative, the patient still developed irreversible extensive pulmonary fibrosis, and respiratory mechanics suggested that lung compliance could not be effectively recovered. After being assisted by ventilator and extracorporeal membrane oxygenation for 73 days, he finally underwent double-lung transplantation. On the 2nd day after the operation, the alveolar lavage fluid of transplanted lung was examined by cytomorphology, and the morphology of alveolar epithelial cells was intact and normal. On the 20th day post-transplantation, the chest radiograph showed a large dense shadow in the middle of the right lung. On the 21st day, the patient underwent fiber-optic bronchoscopy, yeast-like fungal spores were found by cytomorphological examination from a brush smear of the right bronchus, which was confirmed as Candida parapsilosis infection by fungal culture. He recovered well due to the careful treatment and nursing in our hospital. Until July 29, 96 days after transplantation, the patient was recovery and discharged from hospital.

Diagnostic utility of serum beta D glucan test to prescribe antifungal treatment and its effect on patient's outcome: A study from a tertiary care center in Western India

Serum Beta D glucan has 75%-80% sensitivity and 80% specificity to make a diagnosis of invasive candidiasis. Objective(s): This study was designed to understand real-world diagnostic utility of S. Beta D Glucan (BDG) on antifungal prescription patterns associated patient outcomes. Method(s): Study design: Retrospective cohort study Study Population: All consecutive patients who underwent BDG (fungitell assay) testing with conclusive (positive or negative) results in the intensive care unit (ICU) setting between January 1,2021 to December 31,2021 at a tertiary care center in western India. Statistical Methods: We assessed the difference in continuous variables across compared groups using the independent samples t-test and binary logistic regression for categorical variables. We summarize the summary results as odds ratio and 95% confidence intervals. All P-values are 2-sided and set at 5% for all comparisons. All data analyses were performed using IBM SPSS ver 28. Result(s): A total of 4481 patients were admitted in the ICU, of which 198 patients underwent BDG testing. Of the 198,113 tested positive and 61 negative and formed the denominator for the study. Patients with intermediate BDG [24 (12.1%) ] were excluded from the analysis. The mean (SD) age for the study cohort was 57.5 (14.7) years with 30.8% female. All the patients were receiving broad-spectrum antibiotics at the time of BDG collection. A total of 24 study patients had a positive blood culture (23 bacterial isolates and 1 Candida parapsilosis). The groups, positive and negative test results for BDG, were comparable for ventilator usage (P =.737), vasopressor prescription (P =.270), history of surgery (P =.791) central line placement (P =.403), liver disease (P =.144), CKD (P =.424), COVID-19 positivity (P =.238), WBC count (P =.137), CRP (P =.769), and serum procalcitonin (P =.784).Patients with ischemic heart diseases (IHD) (P =.013) and acute kidney injury requiring hemodialysis (AKI/HD) (P =.017) were significantly higher in the test positive group. Test negative group patients received early BDGtesting, mean (SD) stay of 3.33 (3.77) days as compared to 5.61for test positive (6.59) days P=.004).More test-positive patients received antifungal therapy (P <.0001), while 20.4% didn't receive antifungals. Casp ofungin (25.9%), fluconazole (18.4%), anidulafungin (7.5%), voriconazole (6.9%), and combination antifungal were used in 10.9% of study patients. Logistic regression model showed no difference in mortality between the two groups (P =.413) with higher Odds of mortality intest-positive patients (1.357,95%CI0.705-2.609). Treatment with casp ofunginwas associated with higherOdds of mortality (3.497;95% CI1.3249.239, P =.012) as comparedwith fluconazole.Similar trendwas observedwith anidulafungin (OR: 4.089 95% CI 1.052-15.888, P =.042) as compared to fluconazole. This significance remained for casp ofungin [OR 3.607 (1.262-10.311) P =.017] while anidulafungin [OR: 3.934 (0.965-16.032) P =.56] didn't show significance with the multivariate model. Conclusion(s): Probable invasive candidiasis as diagnosed with positive BDG test doesn't increase the risk of mortality. Patients treated with fluconazole were associated with better survival as compared with casp ofungin.

Public health treatment due to rise in Candida auris candidemia infection

Introduction: Isolation of Candida spp. from a blood sample in patients is known as candidemia. Candida albicans is the most common causative agent of candidemia globally while C.tropicalis is the most common causative agent in India.Candida parapsilosis complex, C.glabrata, and C.krusei are the other three common causative agents of candidemia.Candida auris was described in 2009 and is a public health treatment. It is multidrug-resistant and causes localized hospital outbreaks. Objective(s): To determine the fungal profile of candidemia in a tertiary care hospital. Method(s): Institute ethics approval was taken. All patients admitted to the Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India from January 2020 to January 2021, whose blood culture samples yielded yeast were included in the study. The patient's demographic details were recorded. Yeast isolates were identified by Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry (MALDI-T OF MS) as per the manufacture's instruc-tion. The antifungal susceptibility testing (AFST) was performed by microbroth dilution method for fluconazole, voriconazole, amphotericin B, and casp ofungin as per Clinical and Laboratory Standards Institute (CLSI) M27 and interpreted by CLSI M59 and M60 document.AFST of C.auris was interpreted as per Centers for Disease Control and Prevention (CDC) criteria.Results were expressed in percentages. Result(s): A total of 248 blood culture samples yielded yeast cells during the study period. Approximately 63% of samples were obtained from male patients, while 37% were obtained from female patients. Most of the patients were between 41 to 60 years or under 10 years of age. A total of 52/240 (15.8%) were diabetic, and 30 (15.2%) were positive for severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2). Candida tropicalis (34.7%) was the most common causative agent. It was followed by C. parapsilosis complex (20.2%). Candida auris (16.5%), C. albicans (13.3%), C. glabrata (6.5%), and other C. spp. (8.9%). Candida krusei is no longer observed as one of the top five agents of candidemia and it is replaced by C. auris. The rise of candidemia due to C.auris is a cause of concern, and its prevalence is observed more than that of C.albicans in our tertiary care hospital.The antifungal resistant pattern of the top four candidemia isolates is depicted in Figure 1.The antifungal resistance was maximum in C.auris isolates, followed by C.parapsilosis complex isolates.A total of 12.2% of C.auris isolates were resistant to amphotericin B, and azoles and 4.9% of C. auris isolates were multidrug-resistant. Conclusion(s): Candida tropicalis was the most common causative agent of candidemia. But the increased prevalence of C. auris over C. albicans is a cause of concern as 4.9% of C. auris isolates were multidrug-resistant.

Early warning bells: Emergence of fluconazole resistance in Candida parapsilosis

Objectives: To study the susceptibility patterns in blood isolates of Candida parapsilosis at a tertiary care center. Method(s): This was a retrospective observational study of nine cases of candidemia due to C. Parapsilosis over a period of 1 year. Data were collected using the hospital's electronic health records. Species identification was done using Matrix-Assisted Laser Desorption and Ionization-Time of Flight Mass Spectrometry (MALDI-T OF-MS) (Bruker Biotyper Sirius-Bruker Dalton-ics, Bremen, Germany). Antifungal susceptibility was performed by broth microdilution method using Sensititre TM YeastOne TM YO1O AST Plates (Therm ofisher Scientific, USA). Result(s): All patients with C. parapsilosis bloodstream infection had central venous access and all patients had received broad-spectrum antibiotics atthe time of developing candidemia.Fourpatients developed C.parapsilosis candidemiain the post coronavirus disease 2019 (COVID 19) setting.Out of the 9 isolates, 7 (77.7%) were resistant to fluconazole, 2 were resistant to voriconazole and posaconazole, and 1 isolate was resistant to amphotericin.A total of 4/9 patients were started on fluconazole prior to antifungal susceptibility testing;3 of these needed to be switched to an echinocandin due to fluconazole resistance. Conclusion(s): Fluconazole resistance in this study was seen in 7/9 (77.7%) isolates which is more than what has been previously described for C. parapsilosis. This makes fluconazole a poor choice for the treatment of C. parapsilosis in our institute. These findings may have an implication in the selection or de-escalation of antifungal treatment for C. parapsilosis.

Case report of Candida parapsilosis sepsis detected in peripheral blood smear

Introduction During long periods of hospitalization, debilitated and immunosuppressed patients are prone to contracting nosocomial fungal infections, such as Candida parapsilosis, which can cause sepsis. Candida parapsilosis, indeed, is able to form firm and persistent biofilms in central venous catheters (CVC) in addition to other medical devices, thus threatening patients undergoing invasive medical procedures [1]. We report a case of Candida parapsilosis sepsis detected in the peripheral blood smear and by the change of the cytograms of the hematology analyzer before to blood culture positivization. Case presentation An 89-year-old woman, positive for the Sars-Cov2 virus, was admitted at the San Donato hospital (Arezzo) for 40 days for Covid symptoms. Laboratory tests show an increase in C reactive protein (10.6 mg/dL), gamma GT (76 U/L), total bilirubin (2.31 mg/dL) and direct (1.46 mg/ dL), creatinine (1.00 mg/dL ) and reduction of glomerular filtrate (50.4 mL/min /1.73 mq). In addition, at the CBC anemia is detected with hemoglobin of 102 (g/L) and thrombocytopenia (32 x 10

Global Emergence of Resistance to Fluconazole and Voriconazole in Candida parapsilosis in Tertiary Hospitals in Spain During the COVID-19 Pandemic.

Background: Candida parapsilosis is a frequent cause of candidemia worldwide. Its incidence is associated with the use of medical implants, such as central venous catheters or parenteral nutrition. This species has reduced susceptibility to echinocandins, and it is susceptible to polyenes and azoles. Multiple outbreaks caused by fluconazole-nonsusceptible strains have been reported recently. A similar trend has been observed among the C. parapsilosis isolates received in the last 2 years at the Spanish Mycology Reference Laboratory. Methods: Yeast were identified by molecular biology, and antifungal susceptibility testing was performed using the European Committee on Antimicrobial Susceptibility Testing protocol. The ERG11 gene was sequenced to identify resistance mechanisms, and strain typing was carried out by microsatellite analysis. Results: We examined the susceptibility profile of 1315 C. parapsilosis isolates available at our reference laboratory between 2000 and 2021, noticing an increase in the number of isolates with acquired resistance to fluconazole, and voriconazole has increased in at least 8 different Spanish hospitals in 2020-2021. From 121 recorded clones, 3 were identified as the most prevalent in Spain (clone 10 in Catalonia and clone 96 in Castilla-Leon and Madrid, whereas clone 67 was found in 2 geographically unrelated regions, Cantabria and the Balearic Islands). Conclusions: Our data suggest that concurrently with the coronavirus disease 2019 pandemic, a selection of fluconazole-resistant C. parapsilosis isolates has occurred in Spain, and the expansion of specific clones has been noted across centers. Further research is needed to determine the factors that underlie the successful expansion of these clones and their potential genetic relatedness.

Determinants of fluconazole resistance and echinocandin tolerance in C. parapsilosis isolates causing a large clonal candidemia outbreak among COVID-19 patients in a Brazilian ICU.

Patients presenting with severe COVID-19 are predisposed to acquire secondary fungal infections such as COVID-19-associated candidemia (CAC), which are associated with poor clinical outcomes despite antifungal treatment. The extreme burden imposed on clinical facilities during the COVID-19 pandemic has provided a permissive environment for the emergence of clonal outbreaks of multiple Candida species, including C. auris and C. parapsilosis. Here we report the largest clonal CAC outbreak to date caused by fluconazole resistant (FLZR) and echinocandin tolerant (ECT) C. parapsilosis. Sixty C. parapsilosis strains were obtained from 57 patients at a tertiary care hospital in Brazil, 90% of them were FLZR and ECT. Although only 35.8% of FLZR isolates contained an ERG11 mutation, all of them contained the TAC1L518F mutation and significantly overexpressed CDR1. Introduction of TAC1L518F into a susceptible background increased the MIC of fluconazole and voriconazole 8-fold and resulted in significant basal overexpression of CDR1. Additionally, FLZR isolates exclusively harboured E1939G outside of Fks1 hotspot-2, which did not confer echinocandin resistance, but significantly increased ECT. Multilocus microsatellite typing showed that 51/60 (85%) of the FLZR isolates belonged to the same cluster, while the susceptible isolates each represented a distinct lineage. Finally, biofilm production in FLZR isolates was significantly lower than in susceptible counterparts Suggesting that it may not be an outbreak determinant. In summary, we show that TAC1L518F and FKS1E1393G confer FLZR and ECT, respectively, in CAC-associated C. parapsilosis. Our study underscores the importance of antifungal stewardship and effective infection control strategies to mitigate clonal C. parapsilosis outbreaks.

Clinical characteristics and factors influencing development of a pulmonary fungal infection in patients with severe respiratory diseases

Objectives: To examine the clinical characteristics, drug resistance, and factors influencing development of a pulmonary fungal infection in patients with severe respiratory diseases in order to provide a reference for clinical treatment.

Impact of the COVID-19 Pandemic on the Clinical Profile of Candidemia and the Incidence of Fungemia Due to Fluconazole-Resistant Candida parapsilosis.

Severely ill COVID-19 patients are at high risk of nosocomial infections. The aim of the study was to describe the characteristics of candidemia during the pre-pandemic period (January 2019-February 2020) compared to the pandemic period (March 2020-September 2021). Antifungal susceptibilities were assessed using the EUCAST E.Def 7.3.2 broth dilution method. Fluconazole-resistant C. parapsilosis isolates (FRCP) were studied for sequencing of the ERG11 gene. The incidence of candidemia and C. parapsilosis bloodstream infection increased significantly in the pandemic period (p = 0.021). ICU admission, mechanical ventilation, parenteral nutrition and corticosteroids administration were more frequent in patients with candidemia who had been admitted due to COVID-19. Fifteen cases of FRCP fungemia were detected. The first case was recorded 10 months before the pandemic in a patient transferred from another hospital. The incidence of FRCP in patients admitted for COVID-19 was 1.34 and 0.16 in all other patients (p < 0.001). ICU admission, previous Candida spp. colonization, arterial catheter use, parenteral nutrition and renal function replacement therapy were more frequent in patients with candidemia due to FRCP. All FRCP isolates showed the Y132F mutation. In conclusion, the incidence of candidemia experienced an increase during the COVID-19 pandemic and FRCP fungemia was more frequent in patients admitted due to COVID-19.

Invasive Fungal Infections in Critically-ill Patients with COVID-19 in Mexico City

Background. Invasive fungal infections (IFI) are emergent complications in SARS-CoV-2 infection. We aimed to describe the epidemiology, characteristics and outcome of IFI during the pandemic. Methods. Between March 2020 and April 2021, patients admitted to the Intensive Care Unit (ICU) in a COVID-19 center in Mexico City who developed IFI were included. COVID-19 associated pulmonary aspergillosis (CAPA) was defined according to the ECMM/ISHAM criteria. Demographic and clinical data were obtained from the electronic medical record. Descriptive analysis was made. The study was approved by the Institutional Review Board. Results. Sixty-seven (67/743, 9%) patients with COVID-19 developed IFI during ICU stay, of which 37 (55%) had CAPA, 24 (36%) had Invasive Candidiasis (IC), 3 Cryptococcosis and 3 pulmonary Mucormycosis. The median age was 57.5 (IQR 48-68) and 46 (69%) were male. Thirty-six (54%) had obesity and 20 (30%) type 2 diabetes. Sixty-two received COVID-19 directed therapy: 48/67 (72%) steroids, 4/67 (6%) tocilizumab and 8/67 (12%) were included in clinical trials. Among 24 patients with IC, 13 (54%) were fluconazole-resistant C. parapsilosis, 11 (46%) C. albicans and 2 C. glabrata. Twenty-two received antifungal treatment, 20 with echinocandins and 2 fluconazole. Among 37 CAPA, 8 (22%) were probable and 29 (78%) possible. Serum galactomannan was positive in 8 (22%), 33 respiratory cultures grew Aspergillus (31 tracheal aspirates and 2 bronchoalveolar lavage). Aspergillus fumigatus was the most frequent isolate in 18/33 (55%). Chest CT showed ground glass opacities in 21 (57%). Most received voriconazole (26/37, 70%). The median time from ICU admission to IFI was 9.5 (IQR 3-14) days. The median ICU and hospital stay length were 30 days (IQR 16-41) and 40 days (IQR 23-49), respectively. In-hospital mortality was 48%. The incidence rate of IC was higher early in the pandemic, due to Infection Control breaches, while higher CAPA incidence may have occurred later due to ventilation system gaps (Figure 1). Bi-monthly Invasive Fungal Infection incidence rate/100 ICU admissions. Conclusion. We found 9% incidence of IFIs in critically-ill COVID-19 patients with high mortality. The majority received steroids, had obesity and had a prolonged hospital stay. Most had possible CAPA. An outbreak of fluconazole-resistant C. parapsilosis was found.

Characteristics and Outcomes in Hospitalized Patients with Covid-19 Complicated by Fungemia: A Single Center Retrospective Study

Background. Covid19 caused by SARS-CoV2 can lead to significant morbidity and mortality. Fungemia is a rare hospital-associated infection and there are limited data regarding its association with Covid19. We reviewed all cases of fungemia in our Covid19 cohort at Stony Brook University Hospital (SBUH). Methods. We conducted a retrospective medical record review of patients admitted with Covid19 in a 3-month interval. We reviewed positive blood cultures for fungi and recorded co-morbidities, co-infections, length of stay, treatments, and outcomes (survival vs death). There were 60 positive blood cultures for fungi in 25 unique patients (Table 1);in prior years < 30 per year reported at SBUH. Collation of each unique identified fungal species from fungal blood cultures in patients hospitalized with Covid-19 Results. During a 3 month interval at the local peak of the pandemic 1398 patients hospitalized with Covid19 at SBUH, 25 cases of fungemia were detected;C. albicans (CA) n=8,32%, non C albicans species (nCA) n=16,64%, and C. neoformans n=1,4%, 17/25 (68%) also with bacteremia during same hospitalization. In same 3 months there were 264 cases of bacteremia and Covid19 co-infection. Demographics and medical co-morbidities of fungemic patients are in Table 2. Majority were men (76%). No difference between fungaemic (FC) and total cohort (TC) in median age (62 vs 62), DM p=0.31, HTN p=1.0, COPD p=0.12. Within FC, DM was higher in nCA group (58.8%) vs CA group (37%). Mortality was 40% in FC vs 15% in TC, p< 0.001. Within FC mortality was 56% in nCA and 25% in CA group. C. parapsilosis was the most common nCA species isolated with 43% mortality. FC more likely to require ICU and mechanical ventilation (88% vs 15%, p< 0.0001) and had longer median length of stay 42 days vs 22 days. The median time from admission to fungaemia was 21d, from central line placement 19d, Table 3. Of FC 21 (84%) were treated with steroids/Tocilizumab concurrently. Of note, no mortality was recorded in the 4 patients that did not receive steroids/Tocilizumab. PCT and WBC were significantly higher at time of fungemia as compared to admission, Table 3. Relevant patient characteristics and laboratory parameters in patients hospitalized with Covid19 and fungemia Conclusion. Fungemia in hospitalized patients with COVID-19 is associated with higher mortality. We observed higher fatality in non C. albicans infections. Prolonged use of central line catheters and concurrent treatment with steroids/tociluzimab are likely high-risk factors for development of fungemia.

Microbiological Evaluation of Patients Admitted with Acute Respiratory Illness during First Wave of COVID-19 Pandemic in New Delhi, India

Introduction: The Coronavirus Disease 2019 (COVID-19) is associated with damage of cells of both innate and adaptive immunity, which results in immune system's impairment leading to secondary infections. Microbiological evaluation helps in diagnostic as well as antimicrobial stewardship leading to accurate treatment of COVID-19 infected patients. Aim: To evaluate superadded bacterial and fungal infections in COVID-19 infected patients and to evaluate bacterial and fungal infections in COVID-19 non infected patients admitted with Acute Respiratory Illness (ARI). Materials and Methods: This retrospective study was carried out in a tertiary care hospital in Delhi, India, over a period of eight months (May to December, 2020). Respiratory samples, received from indoor patients with history of ARI, were processed for COVID-19 (TrueNat Real Time Polymerase chain reaction) as well as for bacterial and fungal cultures following Standard Operating Procedures (SOP). Identification and susceptibility pattern was evaluated by Vitek2 compact system (bioMérieux, Inc. Durham, North Carolina/USA). Quality control strains used were American Type Culture Collection (ATCC) Staphylococcus aureus 29213, Escherichia coli 25922 and Candida parapsilosis ATCC 22019. Minimum Inhibitory Concentration (MIC) levels were standardised as per Clinical and Laboratory Standards Institute (CLSI) guideline, 2020. All statistical analysis was done by Chi-square test using Software Statistical Package for the Social Sciences (SPSS) version 22.0. Results: Total patients admitted with the history of ARI were 542;COVID-19 Positive Group (CPG) included 115 (21.22%) while COVID-19 Negative Group (CNG) included 427 (78.78%). Growth in bacterial and fungal cultures in CPG was 59.13% (68/115) while in CNG;it was 47.78% (204/427). Among the bacterial isolates, most common isolate was Klebsiella pneumoniae {CPG: 41.93% (26/62);CNG: 36.72% (76/207)}, followed by Pseudomonas aeruginosa {CPG: 33.87% (21/62);CNG: 31.88% (66/207)}. Fungal isolates in CPG was 19.48% (15/77) (p-value 0.0445). On comparing Antimicrobial Susceptibility (AST) pattern of Enterobacterales in both CPG (n=36) and CNG (n=102), no statistically significant difference was observed. Co-morbid conditions were found mostly in CNG 89% (140/158) with ARI while only 11% (18/158) was found in CPG. Conclusion: Secondary respiratory infections are quite common amongst COVID-19 positive patients. However, growth in culture, type of isolates, Antimicrobial Resistance (AMR) was almost similar with COVID-19 non infected patients admitted with ARI. Co-morbidity had the similar impact as COVID-19 infection with respect to co-infections.

A Brazilian Inter-Hospital Candidemia Outbreak Caused by Fluconazole-Resistant Candida parapsilosis in the COVID-19 Era.

Horizontal transmission of fluconazole-resistant Candida parapsilosis (FRCP) through healthcare workers' hands has contributed to the occurrence of candidemia outbreaks worldwide. Since the first COVID-19 case in Brazil was detected in early 2020, hospitals have reinforced hand hygiene and disinfection practices to minimize SARS-CoV-2 contamination. However, a Brazilian cardiology center, which shares ICU patients with a cancer center under a FRCP outbreak since 2019, reported an increased FRCP candidemia incidence in May 2020. Therefore, the purpose of this study was to investigate an inter-hospital candidemia outbreak caused by FRCP isolates during the first year of the COVID-19 pandemic in Brazil. C. parapsilosis bloodstream isolates obtained from the cancer (n = 35) and cardiology (n = 30) centers in 2020 were submitted to microsatellite genotyping and fluconazole susceptibility testing. The ERG11 gene of all isolates from the cardiology center was sequenced and compared to the corresponding sequences of the FRCP genotype responsible for the cancer center outbreak in 2019. Unprecedentedly, most of the FRCP isolates from the cardiology center presented the same genetic profile and Erg11-Y132F mutation detected in the strain that has been causing the persistent outbreak in the cancer center, highlighting the uninterrupted horizontal transmission of clonal isolates in our hospitals during the COVID-19 pandemic.

Antifungal Drug Susceptibility and Genetic Characterization of Fungi Recovered from COVID-19 Patients.

Fungal infections are common complications of respiratory viral infections and are associated with the increased need for intensive care and elevated mortality. Data regarding microbiological and molecular characteristics of such infections in COVID-19 patients are scarce. Here, we performed a comprehensive analysis, including species identification, antifungal susceptibility testing, molecular resistance determinants analysis, typing, and retrospective clinical data review, of fungal isolates recovered from 19 COVID-19 patients, who were hospitalized at the Hackensack University Medical Center (HUMC) in Hackensack, New Jersey, USA, in the initial phase of the pandemic from April-May 2020. In total, 17 Candida albicans, two C. parapsilosis, and two Aspergillus fumigatus were analyzed. All Candida spp. isolates were susceptible to micafungin and azole drugs (fluconazole, voriconazole, posaconazole, itraconazole, isavuconazole). A. fumigatus isolates were susceptible to micafungin and all triazole drugs except fluconazole (intrinsic resistance). Multilocus sequence typing (MLST) of C. albicans isolates revealed 15 different sequence types (STs), which clustered below the clade-defining limit of p-distance < 0.04. Pulsed-field gel electrophoresis (PFGE) karyotyping revealed no chromosomal rearrangements in these isolates. A. fumigatus isolates were of different, non-related genotypes. We speculate that virus- and drug-induced immunosuppression (94.7% of the patients received corticosteroids), together with prolonged hospital stay (median duration of 29 days) and mechanical ventilation (median duration of 24 days) likely increased the susceptibility to secondary respiratory and bloodstream infections in the studied patient population. The presence of fungi in blood or respiratory tract fluid was a prognosticator for poor clinical outcome, which presented as an 89.5% 30-day mortality in our patient cohort.