Format

Send to

Choose Destination
Clin Infect Dis. 2017 Jan 15;64(2):134-140. doi: 10.1093/cid/ciw691. Epub 2016 Oct 20.

Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses.

Author information

1
Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; gyi2@cdc.gov.
2
Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
3
Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, and.
4
Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, India.
5
National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
6
Division of Infectious Diseases, Federal University of São Paulo-UNIFESP, Brazil.
7
Department of Infectious Diseases, School of Medicine, Universidad del Zulia, Maracaibo, Venezuela.
8
Broad Institute, MIT and Harvard, Cambridge, Massachusetts.
9
JMI Laboratories, North Liberty, Iowa.
10
Centers for Disease Control and Prevention Field Epidemiology and Laboratory Training Program, Islamabad, Pakistan.
11
Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, and.
12
Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands.

Abstract

BACKGROUND:

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.

METHODS:

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).

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

Candida auris ; amphotericin B resistance; candidemia; fluconazole resistance; whole genome sequence typing.

PMID:
27988485
PMCID:
PMC5215215
DOI:
10.1093/cid/ciw691
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center