Clinical profile, antifungal susceptibility, and molecular characterization of Candida auris isolated from patients in a South Indian surgical ICU.

Shivaswamy, Umamaheshwari; Neelambike, Sumana M.; Shankarnarayan, Shamanth A.; Kumarswamy, Keerthi Sravanur; Gopal, Shubha; Prakash, Hariprasath; Rudramurthy, Shivaprakash M

doi:10.1016/j.mycmed.2021.101176

Cited by 6 publications

(15 citation statements)

References 42 publications

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“…Similarly, Eyre et al 7 reported that skin surface axillary temperature reusable probes were significantly associated with C. auris colonisation/infection (86% in the patient group versus 34% in controls). Proper surveillance for C. auris colonisation and implementation of infection control practices may stop the spread of C. auris infections/colonisation in COVID‐19 ICU settings 7,37 …”

Section: Discussionmentioning

confidence: 99%

Prevalence, risk factors, treatment and outcome of multidrug resistance Candida auris infections in Coronavirus disease (COVID‐19) patients: A systematic review

Vinayagamoorthy

Pentapati

Prakash³

2022

Mycoses

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Background Candida auris is an emerging multidrug‐resistant pathogen in intensive care settings (ICU). During the coronavirus disease 19 (COVID‐19) pandemic, ICU admissions were overwhelmed, possibly contributing to the C. auris outbreak in COVID‐19 patients. Objectives The present systematic review addresses the prevalence, underlying diseases, iatrogenic risk factors, treatment and outcome of C . auris infections in COVID‐19 patients. Methods MEDLINE, Scopus, Embase, Web of Science and LitCovid databases were systematically searched with appropriate keywords from 1 st January 2020 to 31 st December 2021. Results A total of 97 cases of C. auris were identified in COVID‐19 patients. The prevalence of C. auris infections in COVID‐19 patients was 14%. The major underlying diseases were diabetes mellitus (42.7%), hypertension (32.9%), and obesity (14.6%), followed by the iatrogenic risk factors such as a central venous catheter (76.8%%) intensive care unit (ICU) stay (75.6%), and broad‐spectrum antibiotic usage (74.3%). There were no significant differences in underlying disease and iatrogenic risk factors among C. auris non‐candidemia/colonisation and C. auris candidemia cases. The mortality rate of the total cohort is 44.4%, whereas, in C. auris candidemia patients, the mortality was 64.7%. Conclusion This study shows that the prevalence of C. auris infections remains unchanged in the COVID‐19 pandemic. Hospital‐acquired risk factors may contribute to the clinical illness. Proper infection control practices and hospital surveillance may stop future hospital outbreaks during the pandemic.

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Section: Discussionmentioning

confidence: 99%

Prevalence, risk factors, treatment and outcome of multidrug resistance Candida auris infections in Coronavirus disease (COVID‐19) patients: A systematic review

Vinayagamoorthy

Pentapati

Prakash³

2022

Mycoses

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“…The clinical microbiology community is increasingly reporting an alarming rise in the incidence and spread of drug-resistant C. auris -related cases globally, which are associated with high mortality rates (30–60%) [ 25 , 26 ]. Several current studies have provided extensive documentation of the global antifungal resistance profiles of C. auris isolates to azoles and echinocandins [ 27 , 28 , 29 ]. The need for combination-based antifungal therapy against C. auris stems from the continuous risk of invasive infections, especially in vulnerable immunosuppressed patient populations [ 19 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Synergistic Interaction of Caspofungin Combined with Posaconazole against FKS Wild-Type and Mutant Candida auris Planktonic Cells and Biofilms

et al. 2022

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Candida auris is a potential multidrug-resistant pathogen able to cause biofilm-associated outbreaks, where frequently indwelling devices are the source of infections. The number of effective therapies is limited; thus, new, even-combination-based strategies are needed. Therefore, the in vitro efficacy of caspofungin with posaconazole against FKS wild-type and mutant Candida auris isolates was determined. The interactions were assessed utilizing the fractional inhibitory concentration indices (FICIs), the Bliss model, and a LIVE/DEAD assay. Planktonic minimum inhibitory concentrations (pMICs) for the caspofungin–posaconazole combination showed a 4- to 256-fold and a 2- to 512-fold decrease compared to caspofungin and posaconazole alone, respectively. Sessile minimum inhibitory concentrations (sMICs) for caspofungin and posaconazole in combination showed an 8- to 128-fold and a 4- to 512-fold decrease, respectively. The combination showed synergy, especially against biofilms (FICIs were 0.033–0.375 and 0.091–0.5, and Bliss cumulative synergy volumes were 6.96 and 32.39 for echinocandin-susceptible and -resistant isolates, respectively). The caspofungin-exposed (4 mg/L) C. auris biofilms exhibited increased cell death in the presence of posaconazole (0.03 mg/L) compared to untreated, caspofungin-exposed and posaconazole-treated biofilms. Despite the favorable effect of caspofungin with posaconazole, in vivo studies are needed to confirm the therapeutic potential of this combination in C. auris-associated infections.

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“…The clinical microbiology community is increasingly reporting an alarming rise in the incidence and spread of drug resistant C. auris -related cases globally, which are associated with high mortality rates (30-60%) (Chowdhary et al 2018, van Schalkwyk et al 2019). Several current studies have provided extensive documentation of the global antifungal resistance profiles of C. auris isolates to azoles and echinocandins (Szekely et al 2019, Umamaheshwari et al 2021, Maphanga et al 2021). The need for combination-based antifungal therapy against C. auris stems from the continuous risk of invasive infections, especially in vulnerable immunosuppressed patient populations (Vitale 2021, Bandara and Samaranayake 2022).…”

Section: Discussionmentioning

confidence: 99%

“…Several current studies have provided extensive documentation of the global antifungal resistance profiles of C. auris isolates to azoles and echinocandins (Szekely et al 2019, Umamaheshwari et al 2021, Maphanga et al 2021. The need for combination-based antifungal therapy against C. auris stems from the continuous risk of invasive infections, especially in vulnerable immunosuppressed patient populations (Vitale 2021, Bandara and Samaranayake 2022).…”

Section: Discussionmentioning

confidence: 99%

Synergistic interaction of caspofungin combined with posaconazole against FKS wild-type and mutant Candida auris planktonic cells and biofilms

Balla

Kovács

Balázs

et al. 2022

Preprint

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The in vitro efficacy of caspofungin against FKS wild type and mutant Candida auris isolates was determined in the presence of posaconazole. Drug–drug interactions were assessed utilizing the fractional inhibitory concentration indices (FICIs), the Bliss independence model and a LIVE/DEAD viability assay. Median planktonic minimum inhibitory concentrations (pMICs) of C. auris isolates were between 0.5 and >2 mg/L for caspofungin and between 0.125 and >0.25mg/L for posaconazole. Median pMICs for caspofungin and posaconazole in combination showed a 4- to 256-fold decrease compared to caspofungin and a 2- to 512-fold decrease compared to posaconazole alone. The median sessile minimum inhibitory concentrations (sMICs) of isolates ranged from 32 to >32 mg/L and from 0.06 to >2 mg/L for caspofungin and posaconazole, respectively. Median sMICs for caspofungin and posaconazole in combination showed an 8- to 128-fold decrease compared to caspofungin and a 4- to 512-fold decrease compared to posaconazole alone. Caspofungin and posaconazole showed a synergistic interaction, especially against sessile cells (FICI from 0.033–0.375 and 0.091–0.5, and Bliss cumulative synergy volumes were 6.96 and 32.39 for echinocandin-susceptible and -resistant isolates, respectively). In line with the checkerboard-based findings, synergistic interactions were confirmed by a fluorescent microscopic LIVE/DEAD viability assay. The caspofungin-exposed (4 mg/L) C. auris biofilms exhibited increased cell death in the presence of posaconazole (0.03 mg/L) compared to untreated, caspofungin-exposed and posaconazole-treated sessile cells. The disrupted biofilm structure and increase in cell death was observed for both echinocandin-susceptible and echinocandin-resistant isolates. Despite the favourable effect of caspofungin in the presence of posaconazole, further in vivo studies are needed to confirm the clinical therapeutic potential of this combination when treating C. auris.Contribution to the fieldCandida auris is an emerging fungal pathogen, presumably related to global warming, which is associated with nosocomial infections and is considered a serious health threat worldwide. The treatment of C. auris infections is challenging due to the high level of drug resistance against the traditional antifungal agents. Given the low frequency of resistance to echinocandins, they are recommended as first-line therapy for the management of C. auris infections; however, treatment is complicated by the development of resistance in patients receiving long-term echinocandin treatment. In addition, the biofilm forming ability of this species further complicates the echinocandin-based therapeutic strategies. Combination-based approaches using existing drugs are viable alternatives to overcome the difficult-to-treat C. auris-related infections, including biofilm associated cases. In this study, we examined the in vitro efficacy of caspofungin and posaconazole against FKS wild-type and mutant C. auris planktonic cells and biofilms using classic checkerboard-based investigations and fluorescent imaging. Based on our results, the efficacy of caspofungin and posaconazole is unquestionable, having been confirmed against biofilms, especially in the case of FKS mutants at clinically achievable and safe drug concentrations. This study suggests that the administration of caspofungin with posaconazole may help to expand potential treatment strategies.

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Clinical profile, antifungal susceptibility, and molecular characterization of Candida auris isolated from patients in a South Indian surgical ICU.

Cited by 6 publications

References 42 publications

Prevalence, risk factors, treatment and outcome of multidrug resistance Candida auris infections in Coronavirus disease (COVID‐19) patients: A systematic review

Prevalence, risk factors, treatment and outcome of multidrug resistance Candida auris infections in Coronavirus disease (COVID‐19) patients: A systematic review

Synergistic Interaction of Caspofungin Combined with Posaconazole against FKS Wild-Type and Mutant Candida auris Planktonic Cells and Biofilms

Synergistic interaction of caspofungin combined with posaconazole against FKS wild-type and mutant Candida auris planktonic cells and biofilms

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