Determination of the biofilm formation profile of fluconazole-resistant Candida parapsilosis isolates obtained from a hospital outbreak of candidemia

Abstract

Candida spp. is responsible for more than 80% of nosocomial infections of fungal origin, representing an important cause of morbidity and mortality. Among species, Candida parapsilosis has been more prevalent in neonatal ICUs, but has recently emerged in adult ICUs. The ability of this pathogen to form biofilm and colonize medical devices and the hands of health professionals favors its horizontal transmission and the occurrence of hospital outbreaks, in addition to providing greater pathogenic potential and resistance to antifungals and disinfectants used in the nosocomial environment. Previous studies have observed high mortality rates associated with C. parapsilosis isolates with high or moderate biofilm formation responsible for cases of candidemia, and increasingly more outbreaks caused by isolates resistant to fluconazole have been reported. Therefore, epidemiological surveillance, both of resistance to antifungals and of virulence of isolates, is essential for the control and prevention of infections and hospital outbreaks. The present study aims to determine the biofilm formation profile of C. parapsilosis sensu stricto isolates with a high rate of resistance to fluconazole obtained from hospital surfaces, hands of health professionals and cases of candidemia with a high rate of mortality during an outbreak in a Brazilian reference adult cancer center.