Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses
Clinical Infectious Diseases January 15, 2017 V.64 N.2 P.134-140
Shawn R. Lockhart, Kizee A. Etienne, Snigdha Vallabhaneni, Joveria Farooqi, Anuradha Chowdhary, Nelesh P. Govender, Arnaldo Lopes Colombo, Belinda Calvo, Christina A. Cuomo, Christopher A. Desjardins, Elizabeth L. Berkow, Mariana Castanheira, Rindidzani E. Magobo, Kauser Jabeen, Rana J. Asghar, Jacques F. Meis, Brendan Jackson, Tom Chiller, and Anastasia P. Litvintseva
1 Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia;
2 Broad Institute, MIT and Harvard, Cambridge, Massachusetts;
3 JMI Laboratories, North Liberty, Iowa;
4 Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, and
5 Centers for Disease Control and Prevention Field Epidemiology and Laboratory Training Program, Islamabad, Pakistan;
6 Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, India;
7 National Institute for Communicable Diseases–Centre for Opportunistic, Tropical and Hospital Infections, a Division of the National Health Laboratory Service, Johannesburg, South Africa;
8 Division of Infectious Diseases, Federal University of São Paulo–UNIFESP, Brazil;
9 Department of Infectious Diseases, School of Medicine, Universidad del Zulia, Maracaibo, Venezuela;
10 Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, and
11 Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
Candida auris, a multidrug-resistant yeast that causes invasive infections, was first described in 2009 in Japan and has since been reported from several countries.
To understand the global emergence and epidemiology of C. auris, we obtained isolates from 54 patients with C. auris infection from Pakistan, India, South Africa, and Venezuela during 2012–2015 and the type specimen from Japan. Patient information was available for 41 of the isolates. We conducted antifungal susceptibility testing and whole-genome sequencing (WGS).
Available clinical information revealed that 41% of patients had diabetes mellitus, 51% had undergone recent surgery, 73% had a central venous catheter, and 41% were receiving systemic antifungal therapy when C. auris was isolated. The median time from admission to infection was 19 days (interquartile range, 9–36 days), 61% of patients had bloodstream infection, and 59% died. Using stringent break points, 93% of isolates were resistant to fluconazole, 35% to amphotericin B, and 7% to echinocandins; 41% were resistant to 2 antifungal classes and 4% were resistant to 3 classes. WGS demonstrated that isolates were grouped into unique clades by geographic region. Clades were separated by thousands of single-nucleotide polymorphisms, but within each clade isolates were clonal. Different mutations in ERG11 were associated with azole resistance in each geographic clade.
C. auris is an emerging healthcare-associated pathogen associated with high mortality. Treatment options are limited, due to antifungal resistance. WGS analysis suggests nearly simultaneous, and recent, independent emergence of different clonal populations on 3 continents. Risk factors and transmission mechanisms need to be elucidated to guide control measures.
Entry filed under: Antimicoticos, Biología Molecular, Epidemiología, Health Care-Associated Infections, Infecciones emergentes, Infecciones en diabeticos, Infecciones micoticas, Infecciones nosocomiales, Metodos diagnosticos, REPORTS, Sepsis, Update.