|Publication Type||Journal Article|
|Year of Publication||2017|
|Authors||Lockhart, SR, Etienne, KA, Vallabhaneni, S, Farooqi, J, Chowdhary, A, Govender, NP, Colombo, ALopes, Calvo, B, Cuomo, CA, Desjardins, CA, Berkow, EL, Castanheira, M, Magobo, RE, Jabeen, K, Asghar, RJ, Meis, JF, Jackson, B, Chiller, T, Litvintseva, AP|
|Journal||Clin Infect Dis|
|Date Published||2017 Jan 15|
BACKGROUND: Candida auris, a multidrug-resistant yeast that causes invasive infections, was first described in 2009 in Japan and has since been reported from several countries.
METHODS: To understand the global emergence and epidemiology of C. auris, we obtained isolates from 54 patients with C. auris infection from Pakistan, India, South Africa, and Venezuela during 2012-2015 and the type specimen from Japan. Patient information was available for 41 of the isolates. We conducted antifungal susceptibility testing and whole-genome sequencing (WGS).
RESULTS: Available clinical information revealed that 41% of patients had diabetes mellitus, 51% had undergone recent surgery, 73% had a central venous catheter, and 41% were receiving systemic antifungal therapy when C. auris was isolated. The median time from admission to infection was 19 days (interquartile range, 9-36 days), 61% of patients had bloodstream infection, and 59% died. Using stringent break points, 93% of isolates were resistant to fluconazole, 35% to amphotericin B, and 7% to echinocandins; 41% were resistant to 2 antifungal classes and 4% were resistant to 3 classes. WGS demonstrated that isolates were grouped into unique clades by geographic region. Clades were separated by thousands of single-nucleotide polymorphisms, but within each clade isolates were clonal. Different mutations in ERG11 were associated with azole resistance in each geographic clade.
CONCLUSIONS: C. auris is an emerging healthcare-associated pathogen associated with high mortality. Treatment options are limited, due to antifungal resistance. WGS analysis suggests nearly simultaneous, and recent, independent emergence of different clonal populations on 3 continents. Risk factors and transmission mechanisms need to be elucidated to guide control measures.
|Alternate Journal||Clin. Infect. Dis.|
|PubMed Central ID||PMC5215215|
|Grant List||U19 AI110818 / AI / NIAID NIH HHS / United States|