Isolation of <i>Candida auris</i> from 9 patients in Central America: Importance of accurate diagnosis and susceptibility testing

Araúz, Ana Belén; Cáceres, Diego H.; Santiago, Erika; Armstrong, Paige A.; Arosemena, S Reynaldo; Ramos, Carolina; Espinosa-Bode, Andrés; Borace, Jovanna; Hayer, Lizbeth; Cedeño, Israel; Jackson, Brendan R; Sosa, Néstor; Berkow, Elizabeth L.; Lockhart, Shawn R.; Rodríguez-French, A; Chiller, Tom

doi:10.1111/myc.12709

Cited by 78 publications

(56 citation statements)

References 11 publications

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“…Susceptibility testing using broth microdilution for azoles and echinocandins or gradient diffusion for azoles, echinocandins, and amphotericin B are preferred. Erroneous susceptibility results have been reported for C. auris using the VITEK 2 for amphotericin B [6,35,36]. There are currently no established minimum inhibitory concentration (MIC) breakpoints for susceptibility of C. auris isolates [37].…”

Section: Candida Auris Antifungal Susceptibility Testingmentioning

confidence: 99%

Candida auris: A Review of Recommendations for Detection and Control in Healthcare Settings

Cáceres

Forsberg

Welsh

et al. 2019

JoF

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Candida auris is an emerging multidrug-resistant fungal pathogen. Since first reported in 2009, C. auris has caused healthcare outbreaks around the world, often involving high mortality. Identification of C. auris has been a major challenge as many common conventional laboratory methods cannot accurately detect it. Early detection and implementation of infection control practices can prevent its spread. The aim of this review is to describe recommendations for the detection and control of C. auris in healthcare settings. most common misidentifications based on frequently used yeast identification methods [5,6]. However, efforts to improve C. auris identification methods have made substantial progress in the last few years. The development of a high-salt, high-temperature enrichment culture-based method has made it possible to reliably isolate C. auris from complex sample types [7][8][9]. Once an isolate is obtained, identification of C. auris can be efficiently accomplished with matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. For MALDI-TOF identification, it is important to ensure C. auris is in the reference database [5,6,10]. The Bruker Biotyper (Bruker Daltonik GmbH, Bremen, Germany) and the VITEK MS (bioMérieux, Marcy, L'Etoile, France) include C. auris in their Research Use Only and certain versions of their FDA-approved system databases [3,5,11]. If MALDI-TOF is not available, laboratories can reliably identify an isolate by sequencing the D1-D2 region of the 28s rDNA or the internal transcribed spacer (ITS) regions of rDNA [12][13][14].

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Section: Candida Auris Antifungal Susceptibility Testingmentioning

confidence: 99%

Candida auris: A Review of Recommendations for Detection and Control in Healthcare Settings

Cáceres

Forsberg

Welsh

et al. 2019

JoF

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Section: Introductionmentioning

confidence: 99%

“…Recently, the newly described yeast species Candida auris has emerged as resistant fungal pathogen responsible for hospital outbreaks, in hospitals and especially in intensive care units (ICU), in Asia, the Middle East, Africa, Latin-America, North-America and Europe. [1][2][3][4][5][6][7][8][9][10][11] C. auris has the capacity to survive in the environment for up to 2 weeks despite usual cleaning measures. This feature could be due to the use of cationic surface-active products like quaternary ammonium, disinfectants that until very recently its efficacy against this species was unknown.…”

Section: Introductionmentioning

confidence: 99%

An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital

Ruiz-Gaitán

Moret

Tasias-Pitarch

et al. 2018

Mycoses

245

249

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Multidrug-resistant Candida auris has emerged as a cause of insidious hospital outbreaks and complicated infections. We present the analysis of an ongoing C. auris outbreak including the largest published series of C. auris bloodstream infection. All C. auris-positive patients from April-2016 to January-2017 were included. Environmental, clinical and microbiological data were recorded. Definitive isolate identification was performed by ITS-rDNA sequencing, and typing by amplified fragment length polymorphism fingerprinting. One hundred and forty patients were colonised by C. auris during the studied period (68% from surgical intensive care). Although control measures were implemented, we were not able to control the outbreak. Forty-one invasive bloodstream infections (87.8% from surgical intensive care) were included. Clinical management included prompt intravascular catheter removal and antifungal therapy with echinocandins. All isolates were fluconazole- and voriconazole-resistant, but echinocandin- and amphotericin B-susceptible. Thirty-day mortality rate was 41.4%, and severe septic metastasis as spondylodiscitis and endocarditis were observed in 5 patients (12%). C. auris was also recovered from inanimate patient surroundings and medical equipment. Despite antifungal treatment, high mortality and late complication rates were recorded. Molecular typing suggested a clonal outbreak different from those previously published.

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“…In the Metschnikowiaceae clade, Candida auris as an emerging fungus is associated with invasive infections, high mortality and multidrug‐ resistance . Since 2009, the infection has been reported worldwide from a multitude of clinical manifestations ie, colonisation, mucosal infections, deep‐seated infections and candidaemia within a short period of time . This species exhibits a close phylogenetic relationship with Candida haemulonii and precise species identification is essential for the administration of proper antifungal therapy and the control of outbreaks in healthcare settings .…”

Section: Introductionmentioning

confidence: 99%

Comparative virulence of Candida auris with Candida haemulonii, Candida glabrata and Candida albicans in a murine model

Fakhim

Vaezi

Dannaoui

et al. 2018

Mycoses

101

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The incidence of invasive fungal infections (IFIs) caused by uncommon Candida species with diverse virulence and susceptibility profiles has increased in recent years. Due to scarce clinical and experimental data on the pathogenicity of Candida auris, the aim of this study was to evaluate and compare the virulence of two rare clinically relevant species, C. auris and Candida haemulonii with Candida glabrata and Candida albicans in an immunocompetent murine model of disseminated infection. Immunocompetent ICR female mice were infected with three inoculum sizes (1 × 10 , 1 × 10 and 1 × 10 CFU/mouse) of two C. auris strains and one isolate of C. haemulonii, C. glabrata and C. albicans. Tissue burden on days 5 and 10 postchallenge and mortality rate were used as virulence markers. A high virulence was found for C. albicans, followed by C. auris, C. glabrata and C. haemulonii, respectively. Candida albicans showed high virulence with a medium survival time of 9.5 days for mice infected with 1 × 10 CFU/mouse. For inocula at 1 × 10 and 1 × 10 CFU/mouse, there were significant differences in fungal burden at day 10 between C. albicans, C. auris and C. glabrata isolates compared with C. haemulonii (P < .0001). Overall, no significant differences between C. albicans with C. auris and C. glabrata were observed in mice infected with three different inocula (P > .05). In general, the highest fungal load of all isolates was detected in kidney followed by spleen, liver and lung tested with three different inocula on the two different experimental days. Histopathological examination revealed the abundant presence of yeast cells with pseudohyphae for C. albicans and only yeast cells for C. auris, C. glabrata and C. haemulonii, in all the kidney tissue samples. In conclusion, C. albicans is a highly virulent opportunistic fungus, as the clinical and experimental data demonstrate, and also our results demonstrate a low virulence of C. haemulonii in immunocompetent animals. Altogether, this study highlights the pathogenic potential of C. auris.

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Isolation of Candida auris from 9 patients in Central America: Importance of accurate diagnosis and susceptibility testing

Cited by 78 publications

References 11 publications

Candida auris: A Review of Recommendations for Detection and Control in Healthcare Settings

Candida auris: A Review of Recommendations for Detection and Control in Healthcare Settings

An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital

Comparative virulence of Candida auris with Candida haemulonii, Candida glabrata and Candida albicans in a murine model

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