Increasing prevalence, molecular characterization and antifungal drug susceptibility of serial Candida auris isolates in Kuwait

Khan, Ziauddin; Ahmad, Suhail; Al‐Sweih, Noura; Joseph, Leena; Alfouzan, Wadha; Asadzadeh, Mohammad

doi:10.1371/journal.pone.0195743

Cited by 85 publications

(102 citation statements)

References 46 publications

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“…Three of seven patients were immunocompromised (two had liver transplants and one patient with SLE on immunosuppressant medications). Liver disease and chronic steroid therapy were among the most commonly reported risk factors for C auris infection 2,11 . Surgery is another commonly reported risk factor for C auris 2,21 .…”

Section: Discussionmentioning

confidence: 99%

“…More recently, a fifth clade was described in a patient from Iran 3 . Middle Eastern countries have reported locally acquired cases including in Kuwait, Oman, United Arab Emirates, Iran and Israel 4‐14 . Candida auris poses a challenge in health care settings because it is a multidrug‐resistant pathogen 15,16 and it can cause hospital outbreaks 6,14,17,18 .…”

Section: Introductionmentioning

confidence: 99%

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Molecular characterisation and clinical outcomes of Candida auris infection: Single‐centre experience in Saudi Arabia

Almaghrabi

Albalawi

Mutabagani

et al. 2020

Mycoses

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Summary Background Candida auris is a difficult‐to‐diagnose multidrug‐resistant yeast that can cause invasive infections with high mortality. Since emerging in 2009, this pathogen has been associated with numerous outbreaks around the world. Whole genome sequencing (WGS) is instrumental for understanding the emergence and local transmission of this pathogen. Objectives To describe the clinical, molecular characteristics of Candida auris infection and clinical outcome in our centre. Patients and methods Patients with positive cultures for Candida auris were identified in a microbiology database. Clinical characteristics and antifungal susceptibility were obtained. Isolates were sent to the US CDC for whole genome sequencing. Results Seven unique patients with eight different isolates were identified. Seven isolates were sent to the US CDC for whole genome sequencing. None of the patients had bloodstream infection. Thirty‐day mortality was higher in infected patients compared with those who were colonised. Seven of the eight isolates were resistant to both fluconazole, and five were resistant to amphotericin B. WGS analysis demonstrated that the seven isolates belonged to the South Asian clade but formed two distinct subclades suggesting two independent introductions and ongoing transmission within the facility. Conclusions Candida auris is associated with a high mortality rate in infected patients. Strict infection control measures and surveillance for asymptomatic cases are warranted to halt ongoing transmission.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Molecular characterisation and clinical outcomes of Candida auris infection: Single‐centre experience in Saudi Arabia

Almaghrabi

Albalawi

Mutabagani

et al. 2020

Mycoses

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“…Furthermore, STR typing yielded highly concordant results with WGS and yielded 5 similar distinct groups, which correspond with the four well-known clades from South America, South Africa, South Asia and East Asia, and the possible new clade from Iran. 16,17,31 The allelic variations in the 444 isolates resulted in 40 different genotypes. This relatively low number of different genotypes is partly due to the fact that >95% of our isolates originated from hospital outbreaks, leading to the inclusion of many clonal strains.…”

Section: Discussionmentioning

confidence: 99%

“…For the STR analysis 444 C. auris isolates from Austria(27), Belgium(28), Colombia (hospitals in Barranquilla, Bogota, Cartagena, Medellin, Popayan and Santa Maria), India(29), Iran(30), Japan(29), Korea(29), Kuwait(31), Oman(32), Pakistan(17), Russia(33), South-Africa(29), Spain(26), The Netherlands(34), United Kingdom(35) and Venezuela(6) were used. For a complete overview of isolates see Supplementary Table S2 .…”

Section: Methodsmentioning

confidence: 99%

Development of Candida auris microsatellite typing and its application on a global collection of isolates

Groot

Puts

Berrío

et al. 2019

Preprint

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22Candida auris is a pathogenic yeast that causes invasive infections with high mortality. Infections 23 most often occur in intensive care units of healthcare facilities. It is crucial to trace the source and 24 prevent further spread of C. auris during an outbreak setting, therefore, genotyping of C. auris is 25 required. To enable fast and cost-effective genotyping, we developed a microsatellite typing assay 26 for C. auris. 27 Short tandem repeats (STRs) in C. auris were identified, and a novel STR typing assay for C. auris was 28 developed using 4 panels of three multiplex PCRs. Having shown that the microsatellite typing assay 29 was highly reproducible and specific, a robust set of 444 C. auris isolates was investigated to identify 30 genotypic diversity. In concordance with whole-genome sequencing (WGS) analysis we identified five 31 major different C. auris clusters, namely, South-America, South-Asia, Africa, East-Asia and Iran. 32Overall, a total of 40 distinct genotypes were identified, with the largest variety in the East Asian 33clade. Comparison with WGS demonstrated that isolates with <20 SNPs are mostly not differentiated 34 by STR analysis, while isolates with 30 or more SNPs usually have differences in one or more STR 35 markers. 36Altogether, a highly reproducible and specific microsatellite typing assay for C. auris was developed, 37 which distinguishes the five different C. auris clades in identical fashion to WGS, while most isolates 38 differing >20 SNPs, as determined via WGS, are also separated. This new C. auris specific genotyping 39 technique is a rapid, reliable, cost-effective alternative to WGS analysis to speedily investigate 40 outbreaks. 41 Importance 42Candida auris is an emerging fungal pathogen now recognized as a threat to public health. The 43 pathogen has spread worldwide and mainly causes hospital associated outbreaks. To track and trace 44 outbreaks and to relate them to new introductions from elsewhere, whole genome sequencing and 45 amplified fragment length polymorphism (AFLP) have been used for molecular typing. While the 46 former is costly and only available in few centers, AFLP is a complicated technique and 47 standardization is not possible. We describe a novel simple microsatellite genotyping technique 48 based on small tandem repeats in the C. auris genome. Further we show that this microsatellite 49 based genotyping technique has been proven comparable to WGS. Overall, this work provides a 50 novel, rapid, reliable and cost-effective method of molecular outbreaks investigations of C. auris. 51

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“…C. auris is being increasingly recognised as an emerging, multidrug resistant (MDR) species, causing invasive candidiasis . Candida auris is becoming an important cause of nosocomial blood stream infections (BSIs) in Asia, Africa, America and Europe . The species is frequently misidentified as Candida haemulonii or as several other Candida species by common commercial identification systems .…”

Section: Introductionmentioning

confidence: 99%

Five‐year profile of candidaemia at an Indian trauma centre: High rates of Candida auris blood stream infections

Mathur

Hasan

Singh

et al. 2018

Mycoses

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Candidaemia is a potentially fatal infection with varied distribution of Candida species and their antifungal susceptibility profiles. The recent emergence of Candida auris in invasive candidiasis is a cause for concern. This study describes the profile of candidaemia at an Indian tertiary care hospital and reports the emergence of C. auris. All patients diagnosed with candidaemia between 2012 and 2017 were studied. The isolates were identified using conventional methods, VITEK 2 and MALDI-TOF MS. The isolates not identified by MALDI-TOF were sequenced. Antifungal susceptibility testing was done by the CLSI broth microdilution method and VITEK 2. A total of 114 isolates of Candida species were analysed. Candida tropicalis (39.4%) was the most common species, followed by C. auris (17.5%), C. albicans (14%) and C. parapsilosis (11.4%). Notably, Diutina mesorugosa isolates (n = 10) were not identified by MALDI-TOF and were confirmed by sequencing. Furthermore, 45% (n = 9) C. auris strains exhibited low MICs of FLU (0.05-4 μg/mL) and the remaining 55% (n = 11) isolates had high MICs ≥ 64 μg/mL. Also, D. mesorugosa exhibited high MICs of FLU (32 μg/mL) in 2 isolates. A high rate of errors in antifungal susceptibility was noted with the VITEK 2 as compared to the CLSI method. Candida auris was the second most prevalent species causing candidaemia warranting infection control practices to be strengthened to prevent its spread.

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Increasing prevalence, molecular characterization and antifungal drug susceptibility of serial Candida auris isolates in Kuwait

Cited by 85 publications

References 46 publications

Molecular characterisation and clinical outcomes of Candida auris infection: Single‐centre experience in Saudi Arabia

Molecular characterisation and clinical outcomes of Candida auris infection: Single‐centre experience in Saudi Arabia

Development of Candida auris microsatellite typing and its application on a global collection of isolates

Five‐year profile of candidaemia at an Indian trauma centre: High rates of Candida auris blood stream infections

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