Abstract
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.