Brief report
Characterization, antifungal susceptibility and virulence of Candida parapsilosis complex isolates in a tertiary hospital in Cantabria, Northern Spain
Caracterización, sensibilidad antifúngica y virulencia de aislamientos del complejo Candida parapsilosis en un hospital terciario en Cantabria, norte de España
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class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Microbiology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Molecular Biology, University of Cantabria, Santander, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Caracterización, sensibilidad antifúngica y virulencia de aislamientos del complejo <span class="elsevierStyleItalic">Candida parapsilosis</span> en un hospital terciario en Cantabria, norte de España" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1731 "Ancho" => 2925 "Tamanyo" => 295535 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Fluconazole and echinocandins MIC distribution for the twenty studied <span class="elsevierStyleItalic">Candida</span> isolations.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Candida parapsilosis</span> complex is becoming one of the emerging causes of candidaemia in the world, being the second or third cause of candidaemia, after <span class="elsevierStyleItalic">Candida albicans</span>.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">C. parapsilosis</span> complex is well known as a cause of nosocomial infection, particularly in neonates and especially associated with intravascular devices and parenteral nutrition.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Roy and Meyer in 1998 confirmed, with DNA relatedness and restriction fragment length polymorphism (RFLP) analyses, different genotypes within the <span class="elsevierStyleItalic">C. parapsilosis</span> group, separating them into three subtypes I–III.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> It was Tavanti et al., in 2005, who called the three groups <span class="elsevierStyleItalic">C. parapsilosis</span> sensu stricto (I), <span class="elsevierStyleItalic">Candida orthopsilosis</span> (II), and <span class="elsevierStyleItalic">Candida metapsilosis</span> (III).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> Until recently, the commercial systems did not differentiate these groups, making it necessary to carry out a restriction analysis of polymorphisms in the alcohol dehydrogenase (<span class="elsevierStyleItalic">SADH</span>) gene to differentiate them, common in the three species, also proposed by Tavanti in 2007.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> In 2008, Lockhart et al. added a new subtype to this complex, <span class="elsevierStyleItalic">Lodderomyces elongisporus</span>.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> The matrix-assisted laser desorption/isolation-time of flight mass spectrometry (MALDI-TOF-MS) technique can identify the four subtypes.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The percentage of <span class="elsevierStyleItalic">Candida orthopsilosis</span> (5.1–6.5%) and <span class="elsevierStyleItalic">Candida metapsilosis</span> (1.5–1.8%) subtypes compared to <span class="elsevierStyleItalic">C. parapsilosis</span> sensu stricto is low in the larger series.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6,7</span></a> In Spain, although this percentage was 8.2% and 1.1% respectively in 2011,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> in our hospital these percentages are 4.21% for <span class="elsevierStyleItalic">C. metapsilosis</span> and 1.05% for <span class="elsevierStyleItalic">C. orthopsilosis</span>.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Antifungal susceptibility profiles of the <span class="elsevierStyleItalic">C. parapsilosis</span> species complex reveals only slight differences between the three <span class="elsevierStyleItalic">Candida</span> subspecies, which has suggested that their routine discrimination is not necessary for the clinical laboratory.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> But very few isolates have been compared in those studies.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Taking into account the above, in this study we carried out a characterization of our <span class="elsevierStyleItalic">C.</span><span class="elsevierStyleItalic">parapsilosis</span> species complex isolates in order to: (i) look for phenotypical differences; (ii) check the suitability of MALDI-TOF for identification, (iii) test the antifungal susceptibility, and (iv) assay the biofilm formation.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Candida</span></span><span class="elsevierStyleBold">spp. strains.</span> Twelve <span class="elsevierStyleItalic">C. metapsilosis</span> and eight <span class="elsevierStyleItalic">C. orthopsilosis</span> clinical strains, collected between 2005 and 2019 in the Microbiology Department of the University Hospital Marqués de Valdecilla, Santander, Spain, were chosen. For the global study, a collection of 10 <span class="elsevierStyleItalic">Candida parapsilosis</span> sensu stricto strains, obtained from blood cultures during the same period, were also added to the analysis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The eight <span class="elsevierStyleItalic">C. orthopsilosis</span> strains were collected from: blood cultures (3), urine, external ear exudate (1) and biopsy (1). The 12<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">C. metapsilosis</span> strains were collected from: blood cultures (8), external ear exudate (1), vaginal exudate (1), induced sputum (1) and tracheal aspirate (1).</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Phenotypic automated system</span>. The Vitek®2 with AST-YS8 identification cards (bioMérieux, Marcy-I’Etoile, France) were used for the analysis according to the manufacturer's instructions.</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">MALDI-TOF MS Vitek-MS™ system</span> (bioMérieux, Marcy-I’Etoile, France). Identification of strains was performed following manufacturer's recommendations. Measurement was performed with a Vitek-MS™ instrument supported by SARAMIS MS-IVD v3.0, and v3.2 databases (Anagnos Tee GMBH, BioMérieux).</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Internal Transcribed Spacer (ITS)</span>. The ITS region was amplified with primers described previously by White el al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> The sequences of the isolates were compared with those deposited in the GenBank database using BLAST (<a href="https://blast.ncbi.nlm.nih.gov/Blast.cgi"><span class="elsevierStyleUnderline">https://blast.ncbi.nlm.nih.gov/Blast.cgi</span></a>).</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Antifungal susceptibility test.</span> The antifungigrams were performed with Sensititre™ YeastOne YO10 (TREK Diagnostic Systems, East Grinstead, United Kingdom), following the manufacturer's recommendations. Antimicrobial susceptibility was analyzed according to Clinical and Laboratory Standards Institute (CLSI-M59).</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Static biofilm formation assays</span>. Assays were performed in 96-well polystyrene plates, as previously reported.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> Finally, we filled two plates with samples in triplicate for the two assays and incubated them at 37<span class="elsevierStyleHsp" style=""></span>°C for 24<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Crystal violet biofilm inhibition assay.</span> Biomass formation was quantified after staining with crystal violet (125<span class="elsevierStyleHsp" style=""></span>μL 0.1%) and extracting the crystal violet with acetic acid (125<span class="elsevierStyleHsp" style=""></span>μL 30%). Absorbance was measured at 550<span class="elsevierStyleHsp" style=""></span>nm using a microplate reader (Tecan Microplate Reader, Infinite 200 PRO, Männedorf, Switzerland). Strains were tested in triplicate and classified according to Marcos-Zambrano et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> score as low biofilm forming (LBF; <0.44), moderate biofilm forming (MBF; 0.44–1.17), and high biofilm forming (HBF; >1.17).</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">XTT reduction assay.</span> To quantify biofilm metabolic activity, the reduction of 2.3-Bis-(2-methoxy-4-nitro5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) was measured in the other plate.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> The optical density (OD) value at 490<span class="elsevierStyleHsp" style=""></span>nm was measured using a microplate reader (Tecan Microplate Reader, Infinite 200 PRO, Männedorf, Switzerland). Strains were tested in triplicate and classified based on their metabolic activity using the XTT reduction assay as low metabolic activity (LMA; <0.097), moderate metabolic activity (MMA; 0.097–0.2), and high metabolic activity (HMA; >0.2).<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Data analysis.</span> The statistical analysis was carried out using the SPSS computer software (IBM SPSS Version 20.0). The analysis of differences, in antifungal susceptibility and biofilm formation patterns among subspecies, were evaluated using non-parametric Kruskal–Wallis test.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">MALDI-TOF Vitek-MS™, with v3.2 library version, identified correctly all the isolates with a crude agreement of 100% (20/20) compared to the sequencing. Only some of these strains were analyzed by v3.0 library version, where <span class="elsevierStyleItalic">C. metapsilosis</span> was not included, so it misidentified 44.4% (4/9) of the isolations as <span class="elsevierStyleItalic">C. orthopsilosis</span> and 55.5% (5/9) as <span class="elsevierStyleItalic">C. parapsilosis</span>, while <span class="elsevierStyleItalic">C. orthopsilosis</span> were all correctly identified, 100% (7/7).</p><p id="par0085" class="elsevierStylePara elsevierViewall">Vitek2 didn’t include these species in the database, so the strains were identified only at the species complex level. In an in-depth analysis of AST-YS8 cards in the <span class="elsevierStyleItalic">C. orthopsilosis</span> group 75% (6/8), 87.5% (7/8) and 87.5% (7/8) of the strains turned positive in L-lisine aramidase, D-melobiose assimilation and D-sorbose assimilation, respectively, while only 1% turned positive in <span class="elsevierStyleItalic">C. parapsilosis</span> sensu stricto group and none in <span class="elsevierStyleItalic">C. metapsilosis</span> group. Also, in <span class="elsevierStyleItalic">C. parapsilosis</span> sensu stricto group, tirosin arilamidase became positive in 70% (7/10) of the strains while only in 16.6% (2/12) and 12.5% (1/8) became positive in <span class="elsevierStyleItalic">C. metapsilosis</span> and <span class="elsevierStyleItalic">C. orthopsilosis</span> groups, respectively.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The results of antifungal susceptibility tests confirmed that all isolates were susceptible to the nine antifungals tested. We found significant differences in the susceptibility to fluconazole of <span class="elsevierStyleItalic">C. metapsilosis</span> with respect to <span class="elsevierStyleItalic">C. parapsilopsis</span> (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01). In contrast, we did not find significant differences in susceptibility between <span class="elsevierStyleItalic">C. metapsilosis</span> and <span class="elsevierStyleItalic">C. orthopsilosis</span> (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.14) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The strains were equally susceptible to amphotericin B showing a slightly higher MICs for micafungin and anidulafungin.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">We observed statistically significant differences for micafungin in <span class="elsevierStyleItalic">C. parapsilosis</span> sensu stricto in relation with <span class="elsevierStyleItalic">C. metapsilosis</span> (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01) but not in <span class="elsevierStyleItalic">C. parapsilosis</span> sensu stricto regarding <span class="elsevierStyleItalic">C. orthopsilosis</span> (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.06). On the other hand, the difference in susceptibility to anidulafungin was statistically significant in <span class="elsevierStyleItalic">C. parapsilosis</span> sensu stricto with regard to <span class="elsevierStyleItalic">C. metapsilosis</span> (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01). Conversely, differences between <span class="elsevierStyleItalic">C. parapsilosis</span> sensu stricto and <span class="elsevierStyleItalic">C. orthopsilosis</span> were not statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.078). In fact, <span class="elsevierStyleItalic">C. metapsilosis</span> showed lower MICs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B–D).</p><p id="par0100" class="elsevierStylePara elsevierViewall">We found statistically significant differences between <span class="elsevierStyleItalic">C. parapsilosis</span> sensu stricto and <span class="elsevierStyleItalic">C. metapsilosis</span> (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01). Conversely, the metabolic activity of the strains was not useful to distinguish the species from each other (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Although identification of clinical isolates of <span class="elsevierStyleItalic">C. parapsilosis</span> complex belonging to the subtypes <span class="elsevierStyleItalic">C. metapsilosis</span> and <span class="elsevierStyleItalic">C. orthopsilosis</span> cannot be accomplished following phenotypic systems,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> the results of this study, allow to update the databases of these systems, since not all microbiological laboratories have access to MALDI-TOF systems.</p><p id="par0110" class="elsevierStylePara elsevierViewall">On the other hand, although currently there are very few reported clinical isolates of the two subtypes considered here, this is expected to change with the implementation of new identification systems, such as with the latest version of MALDI-TOF database. This will influence the determination of the real prevalence and incidence, probably increasing the magnitude of the latter with respect to the prevalence.</p><p id="par0115" class="elsevierStylePara elsevierViewall">We can confirm the moderate or high production capacity of biofilm production of the complex in our strains, as previously reported,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> as well as a slightly higher metabolic activity in the <span class="elsevierStyleItalic">C. parapsilosis</span> sensu stricto group (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0120" class="elsevierStylePara elsevierViewall">Finally, we consider desirable the identification of the three subtypes, both for epidemiological surveillance and for the different susceptibility patterns to fluconazole, anidulafungin and micafungin. In our strains, we found <span class="elsevierStyleItalic">C. metapsilosis</span> more resistant than <span class="elsevierStyleItalic">C. parapsilopsis</span> sensu estricto as previously reported,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> but not in <span class="elsevierStyleItalic">C. orthopsilosis</span>, in contrast to de Toro et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> Currently there is no scientific evidence that does not justify the use of fluconazole in <span class="elsevierStyleItalic">C. metapsilosis</span>, but it is worth highlighting the little information available on the epidemiological distribution and resistance of the <span class="elsevierStyleItalic">C. parapsilosis</span> complex. Otherwise, all the strains were equally susceptible to flucytosine in contrast to other authors.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> Finally, the MICs of amphotericin B and echinocandins were lower against <span class="elsevierStyleItalic">C. orthopsilosis</span> and <span class="elsevierStyleItalic">C. metapsilosis</span> than those against <span class="elsevierStyleItalic">C. parapsilosis</span> sensu stricto as in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6,10</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Transparency declarations</span><p id="par0125" class="elsevierStylePara elsevierViewall">All authors have nothing to declare. This study has not been financially supported by any Diagnostic/Pharmaceutical company.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical approval</span><p id="par0130" class="elsevierStylePara elsevierViewall">Not applicable</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0135" class="elsevierStylePara elsevierViewall">This study was supported by <span class="elsevierStyleGrantSponsor" id="gs1">Plan Nacional de I+D+i 2013–2016</span>, <span class="elsevierStyleGrantSponsor" id="gs2">Instituto de Salud Carlos III</span>, <span class="elsevierStyleGrantSponsor" id="gs3">Subdirección General de Redes y Centros de Investigación Cooperativa</span>, <span class="elsevierStyleGrantSponsor" id="gs4">Ministerio de Economía y Competitividad</span>, <span class="elsevierStyleGrantSponsor" id="gs5">Spanish Network for Research in Infectious Diseases</span> (<span class="elsevierStyleGrantNumber" refid="gs5">REIPI RD16/0016/0007</span>).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1843000" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1605838" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1843001" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1605839" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Transparency declarations" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Ethical approval" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 12 => array:2 [ "identificador" => "xack650754" "titulo" => "Acknowledgments" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-05-19" "fechaAceptado" => "2021-08-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1605838" "palabras" => array:5 [ 0 => "<span class="elsevierStyleItalic">Candida parapsilosis</span>" 1 => "<span class="elsevierStyleItalic">Candida orthopsilosis</span>" 2 => "<span class="elsevierStyleItalic">Candida metapsilosis</span>" 3 => "MALDI-TOF MS" 4 => "Biofilm" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1605839" "palabras" => array:5 [ 0 => "<span class="elsevierStyleItalic">Candida parapsilosis</span>" 1 => "<span class="elsevierStyleItalic">Candida orthopsilosis</span>" 2 => "<span class="elsevierStyleItalic">Candida metapsilosis</span>" 3 => "MALDI-TOF MS™" 4 => "Biopelícula" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The correct identification of the species within the <span class="elsevierStyleItalic">Candida parapsilosis</span> complex has become relevant due to the resistance of <span class="elsevierStyleItalic">Candida metapsilosis</span> to antifungals. We describe the characteristics of the <span class="elsevierStyleItalic">Candida parapsilosis</span> complex isolates, with respect to antifungal resistance and biofilm formation.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We perform a descriptive cross-sectional study in 30 strains, collected in a tertiary hospital. All strains, were identified by Vitek2, Vitek-MS™ systems and by ITS sequencing. The antifungal susceptibility profile was obtained with Sensititre™ panels, while biomass production and metabolic activity were quantified by means of crystal violet and XTT reduction assay, respectively.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There was a 100% correlation between Vitek-MS™ and ITS sequencing. All isolates were susceptible to the nine antifungals tested. The metabolic activity and biomass production tests did not show any difference among the subtypes.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The Vitek-MS™ system provides acceptable identification. We did not find significant differences neither in azole resistance nor in biofilm formation.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La correcta identificación del complejo <span class="elsevierStyleItalic">Candida parasilopsis</span> es relevante debido a la resistencia antifúngica de <span class="elsevierStyleItalic">Candida metasilopsis</span>. Describimos las características de aislados del complejo <span class="elsevierStyleItalic">Candida parapsilosis</span> respecto a la resistencia antifúngica y formación de biopelícula.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiza un estudio descriptivo transversal de 30 cepas recolectadas en un hospital terciario. Todas se identificaron por los sistemas Vitek2, MALDI-TOF MS Vitek-MS<span class="elsevierStyleSup">TM</span> y por secuenciación de las regiones ITS. La sensibilidad antifúngica se realizó con paneles Sensititre<span class="elsevierStyleSup">TM</span>. Para la producción de biomasa y la actividad metabólica se emplearon la medición de cristal violeta y el ensayo de reducción de XTT, respectivamente.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Hubo una correlación del 100% entre Vitek-MS<span class="elsevierStyleSup">TM</span> y la secuencia de ITS. Todos los aislados fueron sensibles a los 9 antifúngicos evaluados. Los ensayos de actividad metabólica y producción de biomasa no arrojaron diferencias entre los subtipos.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El sistema Vitek-MS<span class="elsevierStyleSup">TM</span> proporciona una identificación aceptable<span class="elsevierStyleItalic">.</span> No encontramos diferencias significativas ni en la resistencia a azoles ni en la formación de biopelículas.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1731 "Ancho" => 2925 "Tamanyo" => 295535 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Fluconazole and echinocandins MIC distribution for the twenty studied <span class="elsevierStyleItalic">Candida</span> isolations.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">*LBF: low biofilm former, MBF: medium biofilm former, HBF: high biofilm former, LMA: low metabolic activity, MMA: medium metabolic activity, HMA: high metabolic activity, OD: optical density.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Biomass production</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Metabolic activity</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LBF (<0.44 OD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MBF (0.44–1.17 OD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HBF (>1.17 OD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LMA (<0.09 OD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MMA (0.09–0.2 OD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HMA (>0.2 OD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">C. orthopsilosis</span> (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (25%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (25%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (87.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (12.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">C. methapsilosis</span> (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (16.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (66.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (16.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (8.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (75%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (16.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">C. parapsilosis</span> sensu stricto (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (40%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (20%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (40%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (40%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (60%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (26.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (46.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (26.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (3.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (66.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (30%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Strains of <span class="elsevierStyleItalic">Candida parapsilosis</span> complex classified according to the degree of biomass production and metabolic activity.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An investigation of <span class="elsevierStyleItalic">Candida</span> species isolated from blood cultures during 17 years in a university hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. 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Meyer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.36.1.216-218.1998" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "1998" "volumen" => "36" "paginaInicial" => "216" "paginaFinal" => "218" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9431950" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0095" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Candida orthopsilosis</span> and <span class="elsevierStyleItalic">Candida metapsilosis</span> spp. nov. to replace <span class="elsevierStyleItalic">Candida parapsilosis</span> groups II and III" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Tavanti" 1 => "A.D. Davidson" 2 => "N.A. Gow" 3 => "M.C. Maiden" 4 => "F.C. 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Senesi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM. 00243-07" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2007" "volumen" => "45" "paginaInicial" => "1455" "paginaFinal" => "1462" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17329454" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0105" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Lodderomyces elongisporus</span> masquerading as <span class="elsevierStyleItalic">Candida parapsilosis</span> as a cause of bloodstream infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.R. Lockhart" 1 => "S.A. Messer" 2 => "M.A. Pfaller" 3 => "D.J. Diekema" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM. 01790-07" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2008" "volumen" => "46" "paginaInicial" => "374" "paginaFinal" => "376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17959765" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0110" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">In vitro</span> activity of seven systemically active antifungal agents against a large global collection of rare <span class="elsevierStyleItalic">Candida</span> species as determined by CLSI broth microdilution methods" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.J. Diekema" 1 => "S.A. Messer" 2 => "L.B. Boyken" 3 => "R.J. Hollis" 4 => "J. Kroeger" 5 => "S. Tendolkar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM. 00942-09" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2009" "volumen" => "47" "paginaInicial" => "3170" "paginaFinal" => "3177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19710283" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0115" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective multicenter study of the epidemiology, molecular identification, and antifungal susceptibility of <span class="elsevierStyleItalic">Candida parapsilosis</span>, <span class="elsevierStyleItalic">Candida orthopsilosis</span>, and <span class="elsevierStyleItalic">Candida metapsilosis</span> isolated from patients with candidemia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Cantón" 1 => "J. Pemán" 2 => "G. Quindós" 3 => "E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 1 | 6 |
| 2024 October | 24 | 4 | 28 |
| 2024 September | 27 | 23 | 50 |
| 2024 August | 29 | 20 | 49 |
| 2024 July | 14 | 9 | 23 |
| 2024 June | 22 | 4 | 26 |
| 2024 May | 16 | 0 | 16 |
| 2024 April | 23 | 7 | 30 |
| 2024 March | 38 | 3 | 41 |
| 2024 February | 72 | 5 | 77 |
| 2024 January | 18 | 5 | 23 |
| 2023 December | 19 | 1 | 20 |
| 2023 November | 21 | 4 | 25 |
| 2023 October | 42 | 6 | 48 |
| 2023 September | 16 | 3 | 19 |
| 2023 August | 14 | 5 | 19 |
| 2023 July | 2 | 0 | 2 |
| 2023 June | 1 | 0 | 1 |
| 2023 May | 12 | 2 | 14 |
| 2023 April | 2 | 2 | 4 |
| 2023 March | 19 | 4 | 23 |
| 2023 February | 99 | 45 | 144 |
| 2022 May | 0 | 4 | 4 |
| 2022 March | 0 | 2 | 2 |
| 2021 November | 0 | 2 | 2 |
| 2021 October | 0 | 4 | 4 |
| 2021 September | 0 | 6 | 6 |
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