Molecular Epidemiology of Candida auris in Colombia Reveals a Highly Related, Countrywide Colonization With Regional Patterns in Amphotericin B Resistance

Abstract

Our results show that extensive C. auris contamination can occur and highlight the importance of adherence to appropriate infection control practices and disinfection strategies. Observed genetic diversity supports healthcare transmission and a recent expansion of C. auris within Colombia with divergent AmB susceptibility.

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

“…The transmissibility of C. auris is likely also driven by its ability to contaminate the patient care environment. C. auris has been found on healthcare surfaces and medical equipment and can persist on such surfaces for long periods [7,41,42]. Preventing spread of C. auris is dependent on two elements: 1) identification of cases; and 2) implementation of infection control precautions for all identified cases to minimize likelihood of transmission to other patients.…”

The LUFS domain, its transcriptional regulator proteins, and drug resistance in the fungal pathogen Candida auris

“…A recent finding by some of us, obtained via an entirely different approach, again points in the direction of an involvement of Flo8 and its target genes during the efforts of C. auris to establish a persistent infection in its hosts. In a whole‐genome sequence alignment of 78 clinical isolates of C. auris gathered from different hospitals in Colombia, 33 isolates formed a separate clade, which was found to be characterized by a pervasive resistance or reduced susceptibility to AmB (32/33 isolates with minimum inhibitory concentrations or MIC values 0.75–4.0).…”

“…This single nucleotide difference, which translates to the change of a serine (S) in the susceptible isolates to an asparagine (N) in the AmB‐resistant Colombian isolates, represents apparently only a single mutation event (with no documented back mutations), rather than several independent mutation events associated with the independent development of AmB resistance in different places or times. Indeed, the mutation was not found in isolates outside of the clade, either in Colombia or elsewhere. It is not present in AmB‐resistant strains such as strain 6684 in India or B11220 in Japan, nor in AmB susceptible strains such as the reference strain B8441 from Pakistan ( and references therein).…”

“…This apparently new species, which it has been possible to trace back only as far as 1996, has raised considerable public health concern, as well as attracting some media attention (e.g., four New York Times articles by Matt Richtel and colleagues were published in print or online in April 2019 alone). Reasons include difficulties in distinguishing C. auris from some other Candida pathogens, its unusual tolerance to adverse conditions that may contribute to its spread in and between hospitals, and the fact that in some geographic locations, it has developed resistance to one, two, or all three of the major classes of antifungal drugs that are currently in use (see and references therein).…”

“…††For example, in the C. auris assembly B8441_V2 this mutation, named utg5_821828 in Reference , is at position 821,828 of scaffold 4 (C → T, or G → A on the coding strand).…”