Multidrug-Resistant Candida auris Misidentified as Candida haemulonii: Characterization by Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry and DNA Sequencing and Its Antifungal Susceptibility Profile Variability by Vitek 2, CLSI Broth Microdilution, and Etest Method
Shallu Kathuria,Pradeep Kumar Singh,Cheshta Sharma,Anupam Prakash,Aradhana Masih,Anil Kumar,Jacques F. Meis,Anuradha Chowdhary +7 more
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TLDR
A cautionary approach is recommended for laboratories relying on commercial systems for identification and antifungal susceptibility testing of rare yeasts, as 90% of the isolates characterized by commercial identification systems are misidentified as C. auris.Abstract:
Candida auris is a multidrug-resistant yeast that causes a wide spectrum of infections, especially in intensive care settings. We investigated C. auris prevalence among 102 clinical isolates previously identified as Candida haemulonii or Candida famata by the Vitek 2 system. Internal transcribed spacer region (ITS) sequencing confirmed 88.2% of the isolates as C. auris, and matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) easily separated all related species, viz., C. auris (n = 90), C. haemulonii (n = 6), C. haemulonii var. vulnera (n = 1), and Candida duobushaemulonii (n = 5). The in vitro antifungal susceptibility was determined using CLSI broth microdilution (CLSI-BMD), the Vitek 2 antifungal susceptibility test, and the Etest method. C. auris isolates revealed uniformly elevated fluconazole MICs (MIC50, 64 μg/ml), and an alarming percentage of isolates (37%) exhibited elevated caspofungin MICs by CLSI-BMD. Notably, 34% of C. auris isolates had coexisting elevated MICs (≥2 μg/ml) for both fluconazole and voriconazole, and 10% of the isolates had elevated coexisting MICs (≥2 μg/ml) to two additional azoles, i.e., posaconazole and isavuconazole. In contrast to reduced amphotericin B MICs by CLSI-BMD (MIC50, 1 μg/ml) for C. auris, elevated MICs were noted by Vitek 2 (MIC50, 8 μg/ml), which were statistically significant. Candida auris remains an unnoticed pathogen in routine microbiology laboratories, as 90% of the isolates characterized by commercial identification systems are misidentified as C. haemulonii. MALDI-TOF MS proved to be a more robust diagnostic technique for rapid identification of C. auris. Considering that misleading elevated MICs of amphotericin B by the Vitek AST-YS07 card may lead to the selection of inappropriate therapy, a cautionary approach is recommended for laboratories relying on commercial systems for identification and antifungal susceptibility testing of rare yeasts.read more
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Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses
Shawn R. Lockhart,Kizee A. Etienne,Snigdha Vallabhaneni,Joveria Farooqi,Anuradha Chowdhary,Nelesh P. Govender,Arnaldo Lopes Colombo,Belinda Calvo,Christina A. Cuomo,Christopher A. Desjardins,Elizabeth L. Berkow,Mariana Castanheira,Rindidzani E. Magobo,Kauser Jabeen,Rana Jawad Asghar,Jacques F. Meis,Brendan R Jackson,Tom Chiller,Anastasia P. Litvintseva +18 more
TL;DR: Candida auris is an emerging healthcare-associated pathogen associated with high mortality, and WGS analysis suggests nearly simultaneous, and recent, independent emergence of different clonal populations on 3 continents.
Journal ArticleDOI
First hospital outbreak of the globally emerging Candida auris in a European hospital
Silke Schelenz,Ferry Hagen,Johanna Rhodes,Alireza Abdolrasouli,Anuradha Chowdhary,Anne Hall,Lisa Ryan,Joanne Shackleton,Richard Trimlett,Jacques F. Meis,Darius Armstrong-James,Matthew C. Fisher +11 more
TL;DR: This ongoing outbreak with genotypically closely related C. auris highlights the importance of appropriate species identification and rapid detection of cases in order to contain hospital acquired transmission.
Journal ArticleDOI
Candida auris: A rapidly emerging cause of hospital-acquired multidrug-resistant fungal infections globally.
TL;DR: Alarmingly, in a span of only 7 years, this yeast, which is difficult to treat and displays clonal interand intra-hospital transmission, has become widespread across several countries, causing a broad range of healthcare-associated invasive infections.
Journal ArticleDOI
Multidrug-Resistant Candida: Epidemiology, Molecular Mechanisms, and Treatment
TL;DR: Drivers of overall antifungal use, subtherapeutic drug levels at sites of infection/colonization, drug sequestration in the biofilm matrix, and, in the setting of outbreaks, suboptimal infection control are overall antIfungaluse, and recent research suggests that DNA mismatch repair gene mutations may facilitate acquisition of resistance mutations in C. glabrata specifically.
Journal ArticleDOI
Candida auris: a Review of the Literature.
Anna Jeffery-Smith,Surabhi K. Taori,Silke Schelenz,Katie Jeffery,Elizabeth M. Johnson,Andrew M. Borman,Rohini Manuel,Colin S Brown,Colin S Brown +8 more
TL;DR: Genetic analysis indicates the simultaneous emergence of separate clades of this organism in different geographical locations, which will provide direction for further work in this field of Candida auris.
References
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Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital
TL;DR: A single strain of a novel ascomycetous yeast species belonging to the genus Candida was isolated from the external ear canal of an inpatient in a Japanese hospital and indicated that this strain represents a new species with a close phylogenetic relationship to Candida ruelliae and Candida haemulonii in the Metschnikowiaceae clade.
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First Three Reported Cases of Nosocomial Fungemia Caused by Candida auris
TL;DR: The first three cases of nosocomial fungemia caused by C. auris are described, which confirms that it is a causative agent of bloodstream infections and emphasizes the importance of accurately identifying this species.
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Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses
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