<i>Candida auris</i> Sternal Osteomyelitis in a Man from Kenya Visiting Australia, 2015

Heath, Christopher H.; Dyer, John; Pang, Stanley; Coombs, Geoffrey W.; Gardam, Dianne

doi:10.3201/eid2501.181321

Cited by 48 publications

(42 citation statements)

References 6 publications

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“…Risks for C. auris acquisition include admission to a high dependency unit, presence of invasive medical devices, underlying immunocompromise or chronic disease and receipt of antibiotic or antifungal agents . One case of C. auris invasive disease has previously been reported in Australia, but to our knowledge the two cases identified at our facility represent the first possible transmission of C. auris in Australia.…”

Section: Discussionmentioning

confidence: 82%

Candida auris in an Australian health care facility: importance of screening high risk patients

Worth¹,

Harrison

Dickinson

et al. 2020

Medical Journal of Australia

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Section: Discussionmentioning

confidence: 82%

Candida auris in an Australian health care facility: importance of screening high risk patients

Worth¹,

Harrison

Dickinson

et al. 2020

Medical Journal of Australia

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“…We speculate that the epidemic in South Africa might be centered in this area because of a combination of complex and interdependent healthcare system and behavioral factors, including a highly concentrated and mobile patient population; a large number of referrals and admission of patients with clinically complex cases to hospitals in the region; indiscriminate use of antimicrobial agents, including azoles and echinocandins; and suboptimal infection prevention and control practices. In addition, international travel to and from Gauteng Province might also play a role, as suggested by recent case reports and outbreaks in other continents caused by the South Africa clade of C. auris (5,(17)(18)(19)(20). In the United States, 90% of clinical cases of C. auris occurred in the New York metropolitan area, and most patients had lengthy hospitalizations in facilities that had capacity for highly skilled nursing and mechanical ventilation (21), suggesting that a large susceptible population of severely ill patients within a facility might provide a starting point for an outbreak that is then amplified by transmission.…”

Section: Discussionmentioning

confidence: 98%

Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–20171

Schalkwyk¹,

Mpembe²,

Thomas³

et al. 2019

Emerg. Infect. Dis.

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Candida auris is an invasive healthcare-associated fungal pathogen. Cases of candidemia, defined as illness in patients with Candida cultured from blood, were detected through national laboratory-based surveillance in South Africa during 2016-2017. We identified viable isolates by using mass spectrometry and sequencing. Among 6,669 cases (5,876 with species identification) from 269 hospitals, 794 (14%) were caused by C. auris. The incidence risk for all candidemia at 133 hospitals was 83.8 (95% CI 81.2-86.4) cases/100,000 admissions. Prior systemic antifungal drug therapy was associated with a 40% increased adjusted odds of C. auris fungemia compared with bloodstream infection caused by other Candida species (adjusted odds ratio 1.4 [95% CI 0.8-2.3]). The crude in-hospital case-fatality ratio did not differ between Candida species and was 45% for C. auris candidemia, compared with 43% for non-C. auris candidemia. C. auris has caused a major epidemiologic shift in candidemia in South Africa.

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“…Amphotericin B was assessed by Etests (BioMerieux), and resistance was set at ≥2 μg/mL. For isolates not tested at the CDC, similar methods were employed and described previously (17, 19, 48). As there are no currently approved breakpoints for C. auris , for this manuscript breakpoints were set at ≥32 μg/mL for fluconazole, >1 μg/mL for amphotericin B, and ≥4 for micafungin.…”

Section: Methodsmentioning

confidence: 99%

Tracing the evolutionary history and global expansion ofCandida aurisusing population genomic analyses

Chow

Muñoz

Gade

et al. 2020

Preprint

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AbstractCandida auris has emerged globally as a multidrug-resistant yeast that can spread via nosocomial transmission. An initial phylogenetic study of isolates from Japan, India, Pakistan, South Africa, and Venezuela revealed four populations (Clades I, II, III, and IV) corresponding to these geographic regions. Since this description, C. auris has been reported in over 30 additional countries. To trace this global emergence, we compared the genomes of 304 C. auris isolates from 19 countries on six continents. We found that four predominant clades persist across wide geographic locations. We observed phylogeographic mixing in most clades; Clade IV, with isolates mainly from South America, demonstrated the strongest phylogeographic substructure. C. auris isolates from two clades with opposite mating types were detected contemporaneously in a single healthcare facility in Kenya. We estimated a Bayesian molecular clock phylogeny and dated the origin of each clade within the last 339 years; outbreak-causing clusters from Clades I, III, and IV originated 34-35 years ago. We observed high rates of antifungal resistance in Clade I, including four isolates resistant to all three major classes of antifungals. Mutations that contribute to resistance varied between the clades, with Y132F in ERG11 as the most widespread mutation associated with azole resistance and S639P in FKS1 for echinocandin resistance. Copy number variants in ERG11 predominantly appeared in Clade III and were associated with fluconazole resistance. These results provide a global context for the phylogeography, population structure, and mechanisms associated with antifungal resistance in C. auris.ImportanceIn less than a decade, C. auris has emerged in healthcare settings worldwide; this species is capable of colonizing skin and causing outbreaks of invasive candidiasis. In contrast to other Candida species, C. auris is unique in its ability to spread via nosocomial transmission and its high rates of drug resistance. As part of the public health response, whole-genome sequencing has played a major role in characterizing transmission dynamics and detecting new C. auris introductions. Through a global collaboration, we assessed genome evolution of isolates of C. auris from 19 countries. Here, we described estimated timing of the expansion of each C. auris clade and of fluconazole resistance, characterized discrete phylogeographic population structure of each clade, and compared genome data to sensitivity measurements to describe how antifungal resistance mechanisms vary across the population. These efforts are critical for a sustained, robust public health response that effectively utilizes molecular epidemiology.

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Candida auris Sternal Osteomyelitis in a Man from Kenya Visiting Australia, 2015

Cited by 48 publications

References 6 publications

Candida auris in an Australian health care facility: importance of screening high risk patients

Candida auris in an Australian health care facility: importance of screening high risk patients

Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–20171

Tracing the evolutionary history and global expansion ofCandida aurisusing population genomic analyses

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