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Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses
- Source :
- Clinical Infectious Diseases, 64, 134-140, Clinical Infectious Diseases, 64, 2, pp. 134-140
- Publication Year :
- 2016
- Publisher :
- Oxford University Press, 2016.
-
Abstract
- Item does not contain fulltext 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.
- Subjects :
- 0301 basic medicine
Male
Antifungal Agents
Global Health
Cytochrome P-450 Enzyme System
Amphotericin B
Epidemiology
RNA, Ribosomal, 28S
Clade
Child
Pathogen
Phylogeny
Candida
Cross Infection
Transmission (medicine)
Candidiasis
Middle Aged
Drug Resistance, Multiple
Infectious Diseases
Child, Preschool
Female
Genome, Fungal
medicine.drug
Microbiology (medical)
Adult
medicine.medical_specialty
Adolescent
030106 microbiology
Microbial Sensitivity Tests
Biology
Polymorphism, Single Nucleotide
Microbiology
03 medical and health sciences
Young Adult
Drug Resistance, Fungal
DNA, Ribosomal Spacer
medicine
Major Article
Humans
Aged
Whole Genome Sequencing
Errata
Infant, Newborn
Candidemia
Infant
Multiple drug resistance
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
Candida auris
Mutation
Fluconazole
Subjects
Details
- Language :
- English
- ISSN :
- 10584838
- Database :
- OpenAIRE
- Journal :
- Clinical Infectious Diseases, 64, 134-140, Clinical Infectious Diseases, 64, 2, pp. 134-140
- Accession number :
- edsair.doi.dedup.....4a73972d1db6c532d4029f08c9d082ce