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Candida auris 2.0
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Candida auris 2.0

A special issue of Journal of Fungi (ISSN 2309-608X). This special issue belongs to the section "Fungal Pathogenesis and Disease Control".

Deadline for manuscript submissions: closed (30 April 2021) | Viewed by 67878

Special Issue Editors

Prof. Dr. Jacques F. Meis

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Guest Editor
Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), 6532 Nijmegen, The Netherlands
Interests: candida; Candida auris; drug resistance fungal; emerging fungal diseases
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Anuradha Chowdhary

grade E-Mail Website
Guest Editor
Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
Interests: fungal infections; Candida; Aspergillus; dermatophytes; antifungal resistance
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This year marks the 11th anniversary of the first formal description of Candida auris, isolated from the external ear of a Japanese patient in 2009. Retrospective studies of culture collections of yeasts from before 2009 only showed single isolates from Korea in 1996 (the earliest known isolate to date) and from Pakistan in 2008. In a relatively short period, C. auris was able to spread all over the world, mainly in hospitals, and has now been reported from six continents and more than 40 countries. Several countries have reported persistent problems and prolonged outbreaks in healthcare facilities. Unlike other Candida spp., C. auris seems to colonize the skin of patients and can contaminate hospital environments.

C. auris is easily transmitted in healthcare settings and is the first fungus to behave like an epidemic nosocomial bacterial pathogen. Transmission within and between hospitals and nursing home facilities confronts us with major infection control challenges, prompting authorities in the US to declare colonization or infection with C. auris as a notifiable disease from 2019 onwards. More than 90% of C. auris isolates are fluconazole resistant, with some rare isolates also being resistant to all three major antifungal classes, leaving no possible treatment options. A major explanation for the quick worldwide spread was that C. auris is often misidentified as other Candida spp., notably C. haemulonii, or as Saccharomyces when identification methods based on phenotype are used. Manufacturers are now working to solve this problem of routine identification, though molecular methods or MALDI-TOF can reliably identify C. auris. We invite you to consider submitting the results of your latest original studies or clinical cases involving this special pathogen, C. auris, to this Special Issue of the Journal of Fungi.

Prof. Dr. Jacques F. Meis
Prof. Dr. Anuradha Chowdhary
Guest Editors

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Keywords

  • candida
  • Candida auris
  • drug-resistant fungi
  • infection control
  • emerging fungal diseases

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Published Papers (16 papers)

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14 pages, 2631 KiB  
Communication
Diagnostic Allele-Specific PCR for the Identification of Candida auris Clades
by Hans Carolus, Stef Jacobs, Celia Lobo Romero, Quinten Deparis, Christina A. Cuomo, Jacques F. Meis and Patrick Van Dijck
J. Fungi 2021, 7(9), 754; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7090754 - 13 Sep 2021
Cited by 8 | Viewed by 3058
Abstract
Candida auris is an opportunistic pathogenic yeast that emerged worldwide during the past decade. This fungal pathogen poses a significant public health threat due to common multidrug resistance (MDR), alarming hospital outbreaks, and frequent misidentification. Genomic analyses have identified five distinct clades that [...] Read more.
Candida auris is an opportunistic pathogenic yeast that emerged worldwide during the past decade. This fungal pathogen poses a significant public health threat due to common multidrug resistance (MDR), alarming hospital outbreaks, and frequent misidentification. Genomic analyses have identified five distinct clades that are linked to five geographic areas of origin and characterized by differences in several phenotypic traits such as virulence and drug resistance. Typing of C. auris strains and the identification of clades can be a powerful tool in molecular epidemiology and might be of clinical importance by estimating outbreak and MDR potential. As C. auris has caused global outbreaks, including in low-income countries, typing C. auris strains quickly and inexpensively is highly valuable. We report five allele-specific polymerase chain reaction (AS-PCR) assays for the identification of C. auris and each of the five described clades of C. auris based on conserved mutations in the internal transcribed spacer (ITS) rDNA region and a clade-specific gene cluster. This PCR method provides a fast, cheap, sequencing-free diagnostic tool for the identification of C. auris, C. auris clades, and potentially, the discovery of new clades. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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14 pages, 4234 KiB  
Article
Cell Surface Expression of Nrg1 Protein in Candida auris
by Anuja Paudyal and Govindsamy Vediyappan
J. Fungi 2021, 7(4), 262; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7040262 - 31 Mar 2021
Cited by 5 | Viewed by 2299
Abstract
Candida auris is an emerging antifungal resistant human fungal pathogen increasingly reported in healthcare facilities. It persists in hospital environments, and on skin surfaces, and can form biofilms readily. Here, we investigated the cell surface proteins from C. auris biofilms grown in a [...] Read more.
Candida auris is an emerging antifungal resistant human fungal pathogen increasingly reported in healthcare facilities. It persists in hospital environments, and on skin surfaces, and can form biofilms readily. Here, we investigated the cell surface proteins from C. auris biofilms grown in a synthetic sweat medium mimicking human skin conditions. Cell surface proteins from both biofilm and planktonic control cells were extracted with a buffer containing β-mercaptoethanol and resolved by 2-D gel electrophoresis. Some of the differentially expressed proteins were excised and identified by mass spectrometry. C. albicans orthologs Spe3p, Tdh3p, Sod2p, Ywp1p, and Mdh1p were overexpressed in biofilm cells when compared to the planktonic cells of C. auris. Interestingly, several proteins with zinc ion binding activity were detected. Nrg1p is a zinc-binding transcription factor that negatively regulates hyphal growth in C. albicans. C. auris does not produce true hypha under standard in vitro growth conditions, and the role of Nrg1p in C. auris is currently unknown. Western blot analyses of cell surface and cytosolic proteins of C. auris against anti-CalNrg1 antibody revealed the Nrg1p in both locations. Cell surface localization of Nrg1p in C. auris, an unexpected finding, was further confirmed by immunofluorescence microscopy. Nrg1p expression is uniform across all four clades of C. auris and is dependent on growth conditions. Taken together, the data indicate that C. auris produces several unique proteins during its biofilm growth, which may assist in the skin-colonizing lifestyle of the fungus during its pathogenesis. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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10 pages, 669 KiB  
Article
Genomic Epidemiology of Candida auris in Qatar Reveals Hospital Transmission Dynamics and a South Asian Origin
by Husam Salah, Sathyavathi Sundararaju, Lamya Dalil, Sarah Salameh, Walid Al-Wali, Patrick Tang, Fatma Ben Abid and Clement K. M. Tsui
J. Fungi 2021, 7(3), 240; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7030240 - 23 Mar 2021
Cited by 15 | Viewed by 2965
Abstract
Candida auris is an emerging, multidrug-resistant fungal pathogen that has become a public health threat with an increasing incidence of infections worldwide. Candida auris spreads easily among patients within and between hospitals. Infections and outbreaks caused by C. auris have been reported in [...] Read more.
Candida auris is an emerging, multidrug-resistant fungal pathogen that has become a public health threat with an increasing incidence of infections worldwide. Candida auris spreads easily among patients within and between hospitals. Infections and outbreaks caused by C. auris have been reported in the Middle East region including Oman, Kuwait, Saudi Arabia, and Qatar; however, the origin of these isolates is largely unknown. Pathogen whole genome sequencing (WGS) was used to determine the epidemiology and drug resistance mutations of C. auris in Qatar. Forty-four samples isolated from patients in three hospitals and the hospital environment were sequenced by Illumina NextSeq. Core genome single nucleotide polymorphisms (SNPs) revealed that all isolates belonged to the South Asian lineage with genetic heterogeneity that suggests previous acquisition from foreign healthcare. The genetic variability among the outbreak isolates in the two hospitals (A and B) was low. Four environmental isolates clustered with the related clinical isolates, and epidemiologically linked isolates clustered together, suggesting that the ongoing transmission of C. auris could be linked to infected/colonized patients and the hospital environment. Prominent mutations Y132F and K143R in ERG11 linked to increased fluconazole resistance were detected. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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7 pages, 450 KiB  
Article
Candida auris Whole-Genome Sequence Benchmark Dataset for Phylogenomic Pipelines
by Rory M. Welsh, Elizabeth Misas, Kaitlin Forsberg, Meghan Lyman and Nancy A. Chow
J. Fungi 2021, 7(3), 214; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7030214 - 16 Mar 2021
Cited by 15 | Viewed by 3128
Abstract
Candida auris is a multidrug-resistant pathogen that represents a serious public health threat due to its rapid global emergence, increasing incidence of healthcare-associated outbreaks, and high rates of antifungal resistance. Whole-genome sequencing and genomic surveillance have the potential to bolster C. auris surveillance [...] Read more.
Candida auris is a multidrug-resistant pathogen that represents a serious public health threat due to its rapid global emergence, increasing incidence of healthcare-associated outbreaks, and high rates of antifungal resistance. Whole-genome sequencing and genomic surveillance have the potential to bolster C. auris surveillance networks moving forward. Laboratories conducting genomic surveillance need to be able to compare analyses from various national and international surveillance partners to ensure that results are mutually trusted and understood. Therefore, we established an empirical outbreak benchmark dataset consisting of 23 C. auris genomes to help validate comparisons of genomic analyses and facilitate communication among surveillance networks. Our outbreak benchmark dataset represents a polyclonal phylogeny with three subclades. The genomes in this dataset are from well-vetted studies that are supported by multiple lines of evidence, which demonstrate that the whole-genome sequencing data, phylogenetic tree, and epidemiological data are all in agreement. This C. auris benchmark set allows for standardized comparisons of phylogenomic pipelines, ultimately promoting effective C. auris collaborations. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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7 pages, 449 KiB  
Article
Comparison of Two Commercially Available qPCR Kits for the Detection of Candida auris
by Janko Sattler, Janina Noster, Anne Brunke, Georg Plum, Pia Wiegel, Oliver Kurzai, Jacques F. Meis and Axel Hamprecht
J. Fungi 2021, 7(2), 154; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7020154 - 22 Feb 2021
Cited by 13 | Viewed by 3225
Abstract
Candida auris is an emerging pathogen with resistance to many commonly used antifungal agents. Infections with C. auris require rapid and reliable detection methods to initiate successful medical treatment and contain hospital outbreaks. Conventional identification methods are prone to errors and can lead [...] Read more.
Candida auris is an emerging pathogen with resistance to many commonly used antifungal agents. Infections with C. auris require rapid and reliable detection methods to initiate successful medical treatment and contain hospital outbreaks. Conventional identification methods are prone to errors and can lead to misidentifications. PCR-based assays, in turn, can provide reliable results with low turnaround times. However, only limited data are available on the performance of commercially available assays for C. auris detection. In the present study, the two commercially available PCR assays AurisID (OLM, Newcastle Upon Tyne, UK) and Fungiplex Candida Auris RUO Real-Time PCR (Bruker, Bremen, Germany) were challenged with 29 C. auris isolates from all five clades and eight other Candida species as controls. AurisID reliably detected C. auris with a limit of detection (LoD) of 1 genome copies/reaction. However, false positive results were obtained with high DNA amounts of the closely related species C. haemulonii, C. duobushaemulonii and C. pseudohaemulonii. The Fungiplex Candida Auris RUO Real-Time PCR kit detected C. auris with an LoD of 9 copies/reaction. No false positive results were obtained with this assay. In addition, C. auris could also be detected in human blood samples spiked with pure fungal cultures by both kits. In summary, both kits could detect C. auris-DNA at low DNA concentrations but differed slightly in their limits of detection and specificity. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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11 pages, 1928 KiB  
Article
Molecular Epidemiological Investigation of a Nosocomial Cluster of C. auris: Evidence of Recent Emergence in Italy and Ease of Transmission during the COVID-19 Pandemic
by Vincenzo Di Pilato, Giulia Codda, Lorenzo Ball, Daniele Roberto Giacobbe, Edward Willison, Malgorzata Mikulska, Laura Magnasco, Francesca Crea, Antonio Vena, Paolo Pelosi, Matteo Bassetti and Anna Marchese
J. Fungi 2021, 7(2), 140; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7020140 - 15 Feb 2021
Cited by 54 | Viewed by 4801
Abstract
Candida auris is an emerging MDR pathogen raising major concerns worldwide. In Italy, it was first and only identified in July 2019 in our hospital (San Martino Hospital, Genoa), where infection or colonization cases have been increasingly recognized during the following months. To [...] Read more.
Candida auris is an emerging MDR pathogen raising major concerns worldwide. In Italy, it was first and only identified in July 2019 in our hospital (San Martino Hospital, Genoa), where infection or colonization cases have been increasingly recognized during the following months. To gain insights into the introduction, transmission dynamics, and resistance traits of this fungal pathogen, consecutive C. auris isolates collected from July 2019 to May 2020 (n = 10) were subjected to whole-genome sequencing (WGS) and antifungal susceptibility testing (AST); patients’ clinical and trace data were also collected. WGS resolved all isolates within the genetic clade I (South Asian) and showed that all but one were part of a cluster likely stemming from the index case. Phylogenetic molecular clock analyses predicted a recent introduction (May 2019) in the hospital setting and suggested that most transmissions were associated with a ward converted to a COVID-19-dedicated ICU during the pandemic. All isolates were resistant to amphotericin B, voriconazole, and fluconazole at high-level, owing to mutations in ERG11(K143R) and TACB1(A640V). Present data demonstrated that the introduction of MDR C. auris in Italy was a recent event and suggested that its spread could have been facilitated by the COVID-19 pandemic. Continued efforts to implement stringent infection prevention and control strategies are warranted to limit the spread of this emerging pathogen within the healthcare system. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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16 pages, 1256 KiB  
Article
Colonisation and Transmission Dynamics of Candida auris among Chronic Respiratory Diseases Patients Hospitalised in a Chest Hospital, Delhi, India: A Comparative Analysis of Whole Genome Sequencing and Microsatellite Typing
by Anamika Yadav, Anubhav Singh, Yue Wang, Merlijn HI van Haren, Ashutosh Singh, Theun de Groot, Jacques F. Meis, Jianping Xu and Anuradha Chowdhary
J. Fungi 2021, 7(2), 81; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7020081 - 26 Jan 2021
Cited by 33 | Viewed by 3939
Abstract
Candida auris is a nosocomial pathogen responsible for an expanding global public health threat. This ascomycete yeast has been frequently isolated from hospital environments, representing a significant reservoir for transmission in healthcare settings. Here, we investigated the relationships among C. auris isolates from [...] Read more.
Candida auris is a nosocomial pathogen responsible for an expanding global public health threat. This ascomycete yeast has been frequently isolated from hospital environments, representing a significant reservoir for transmission in healthcare settings. Here, we investigated the relationships among C. auris isolates from patients with chronic respiratory diseases admitted in a chest hospital and from their fomites, using whole-genome sequencing (WGS) and multilocus microsatellite genotyping. Overall, 37.5% (n = 12/32) patients developed colonisation by C. auris including 9.3% of the screened patients that were colonised at the time of admission and 75% remained colonised till discharge. Furthermore, 10% of fomite samples contained C. auris in rooms about 8.5 days after C. auris colonised patients were admitted. WGS and microsatellite typing revealed that multiple strains contaminated the fomites and colonised different body sites of patients. Notably, 37% of C. auris isolates were resistant to amphotericin B but with no amino acid substitution in ERG2, ERG3, ERG5, and ERG6 as compared to the reference strain B8441 in any of our strains. In addition, 55% of C. auris isolates likely had two copies of the MDR1 gene. Our results suggest significant genetic and ecological diversities of C. auris in healthcare setting. The WGS and microsatellite genotyping methods provided complementary results in genotype identification. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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10 pages, 776 KiB  
Article
Antifungal Activity of a Medical-Grade Honey Formulation against Candida auris
by Theun de Groot, Tom Janssen, Dirk Faro, Niels A. J. Cremers, Anuradha Chowdhary and Jacques F. Meis
J. Fungi 2021, 7(1), 50; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7010050 - 13 Jan 2021
Cited by 27 | Viewed by 5059
Abstract
Candida auris is a pathogenic yeast causing outbreaks in intensive care units with high mortality rates. The treatment of C. auris colonization is challenging due to high resistance rates. A potential alternative antifungal treatment is medical-grade honey. In this study the susceptibility of [...] Read more.
Candida auris is a pathogenic yeast causing outbreaks in intensive care units with high mortality rates. The treatment of C. auris colonization is challenging due to high resistance rates. A potential alternative antifungal treatment is medical-grade honey. In this study the susceptibility of C. auris and other Candida species to the medical-grade honey-based formulation L-Mesitran® Soft was investigated. The medical-grade honey formulation reduced the growth of C. auris and other Candida species in a dose-dependent manner. This inhibition was not only due to the honey component, as treatment with an identical concentration of this component only was less effective and even stimulated the growth of C. albicans and C. glabrata, supporting the interpretation that supplements in the medical-grade honey formulation enhanced the antimicrobial activity. Increasing the concentration of the honey component to 40%, as is also present in an undiluted medical-grade honey formulation, lead to a 1- to 4-log inhibition of all Candida species. Unprocessed local honey reduced the growth of nearly all Candida species more strongly than medical-grade honey. C. auris’ susceptibility to the medical-grade honey formulation did not depend on geographic origin or resistance profile, although the multiresistant isolates tended to be more susceptible. Altogether, medical-grade honey formulation has a strong antifungal activity against C. auris and other Candida species. Future studies should demonstrate whether the treatment of open wounds or skin colonized with C. auris is feasible and effective in the clinical setting. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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12 pages, 2740 KiB  
Article
Characteristics, Risk Factors, and Survival Analysis of Candida auris Cases: Results of One-Year National Surveillance Data from Oman
by Azza Al-Rashdi, Amal Al-Maani, Adil Al-Wahaibi, Abdullah Alqayoudhi, Amina Al-Jardani and Seif Al-Abri
J. Fungi 2021, 7(1), 31; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7010031 - 07 Jan 2021
Cited by 20 | Viewed by 3121
Abstract
Background: Candida auris (C. auris) is an emerging healthcare-associated pathogen resulting in significant morbidity and mortality. The aim of this study is to report data from the national C. auris surveillance system for 2019 and conduct a survival analysis of the [...] Read more.
Background: Candida auris (C. auris) is an emerging healthcare-associated pathogen resulting in significant morbidity and mortality. The aim of this study is to report data from the national C. auris surveillance system for 2019 and conduct a survival analysis of the reported cohort. Methods: a retrospective analysis was conducted for all C. auris cases reported nationally to the Oman Antimicrobial Surveillance System (OMASS) in 2019, and isolates were sent to the Central Public Health Laboratories (CPHL). Clinical and demographic data were obtained through the E-Surveillance reporting system and the Electronic System (NEHR Al-Shifa) at CPHL. Statistical analysis was done using Kaplan–Meier analysis and Cox proportional hazard models. Results: One hundred and twenty-nine isolates of C. auris were grown from 108 inpatients; 87% were isolated from clinical samples, of which blood was the most common (38.9%). Forty (37%) were ≥65 years of age, 72 (66.7%) were males, and 85 (78.7%) were Omani nationals. Of the total isolates, 43.5% were considered as colonization; 56.5% were considered infection, of which 61.8% of them were candidemia. At least one risk factor was present in 98.1% of patients. The mean time from admission to infection was 1.7 months (SD = 2.8), and the mean length of hospital stay was 3.5 months (SD = 4). Totals of 94.8% and 96.1% of the isolates were non-susceptible to fluconazole and amphotericin, respectively. The variables found to be significantly associated with longer survival post C. auris diagnosis (p < 0.05) were age < 65 years, absence of comorbidities, length of stay < 3 months, colonization, and absence of candidemia. The infection fatality rate was 52.5%. Conclusion: Including C. auris in an ongoing antimicrobial surveillance program provides important data for the comprehensive management of this growing public health threat. The current study shows health care outbreaks of C. auris are ongoing, with 52.5% infection fatality, although our isolates remained sensitive to Echinocandins in vitro. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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9 pages, 1017 KiB  
Article
Drug Resistance-Associated Mutations in ERG11 of Multidrug-Resistant Candida auris in a Tertiary Care Hospital of Eastern Saudi Arabia
by Reem AlJindan, Doaa M. AlEraky, Nehal Mahmoud, Baha Abdalhamid, Mashael Almustafa, Sayed AbdulAzeez and J. Francis Borgio
J. Fungi 2021, 7(1), 18; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7010018 - 31 Dec 2020
Cited by 12 | Viewed by 3716
Abstract
Candida auris is an emerging multi-drug resistant pathogen with high mortality rate; nosocomial infections have been reported worldwide, causing a major challenge for clinicians and microbiological laboratories. The study aims to describe new cases of C. auris and detect drug resistance-associated mutations of [...] Read more.
Candida auris is an emerging multi-drug resistant pathogen with high mortality rate; nosocomial infections have been reported worldwide, causing a major challenge for clinicians and microbiological laboratories. The study aims to describe new cases of C. auris and detect drug resistance-associated mutations of C. auris by the sequencing of ERG11 and FKS1 genes. A total of six specimens were collected from blood, urine, ear swab, and groin screening samples. Isolates were incubated for 48 h on Sabouraud Dextrose agar (SDA) at 42 °C, then confirmed by MALDI-TOF MS. Furthermore, antifungal susceptibility testing was performed using the Vitek 2 system to detect Minimum Inhibitory Concentrations (MICs) of six antifungals. Sequences of 18S rRNA gene and ITS regions from isolates and phylogenetic analysis were performed. Gene sequencing was analysed to detect drug resistance-associated mutations by FKS1 and ERG11 genes sequencing. All C. auris isolates were confirmed by MALDI-TOF MS, and evolutionary analyses using sequences of 18S rRNA gene and ITS region. Antifungal susceptibility testing showed that all isolates were resistant to fluconazole. Sequencing of ERG11 and FKS1 genes from the isolates revealed the presence of two (F132Y and K143R) drug resistance-associated mutations in ERG11, however, FKS1 gene was devoid of mutations. The study sheds light on a public health threat of an emerging pathogen, and the hospital implemented strict contact screening and infection control precautions to prevent C. auris infection. Finally, there is a critical need to monitor the antifungal resistance in different geographical areas and implementation of efficient guidelines for treatment. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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18 pages, 1410 KiB  
Article
Molecular Epidemiology of Candida Auris Outbreak in a Major Secondary-Care Hospital in Kuwait
by Wadha Alfouzan, Suhail Ahmad, Rita Dhar, Mohammad Asadzadeh, Noura Almerdasi, Naglaa M. Abdo, Leena Joseph, Theun de Groot, Walid Q. Alali, Ziauddin Khan, Jacques F. Meis and Mohammad R. Al-Rashidi
J. Fungi 2020, 6(4), 307; https://0-doi-org.brum.beds.ac.uk/10.3390/jof6040307 - 21 Nov 2020
Cited by 37 | Viewed by 3629
Abstract
The emerging, often multidrug-resistant Candida auris is increasingly being associated with outbreaks in healthcare facilities. Here we describe the molecular epidemiology of a C. auris outbreak during 18 months, which started in 2018 in the high dependency unit (HDU) of a secondary-care hospital [...] Read more.
The emerging, often multidrug-resistant Candida auris is increasingly being associated with outbreaks in healthcare facilities. Here we describe the molecular epidemiology of a C. auris outbreak during 18 months, which started in 2018 in the high dependency unit (HDU) of a secondary-care hospital in Kuwait. Demographic and clinical data for candidemia and colonized patients were prospectively recorded. Clinical and environmental isolates were subjected to phenotypic and molecular identification; antifungal susceptibility testing by broth microdilution method; PCR-sequencing of ERG11 and FKS1 for resistance mechanisms to triazoles and echinocandins, respectively; and molecular fingerprinting by short tandem repeat (STR) analyses. Seventy-one (17 candidemic and 54 colonized) patients including 26 with candiduria and seven environmental samples yielded C. auris. All isolates were identified as C. auris by Vitek2, MALDI-TOF MS, PCR amplification and/or PCR-sequencing of rDNA. Twelve candidemia and 26 colonized patients were admitted or exposed to HDU. Following outbreak recognition, an intensive screening program was instituted for new patients. Despite treatment of all candidemia and 36 colonized patients, 9 of 17 candidemia and 27 of 54 colonized patients died with an overall crude mortality rate of ~50%. Nearly all isolates were resistant to fluconazole and contained the Y132F mutation in ERG11 except one patient’s isolates, which were also distinct by STR typing. Only urine isolates from two patients developed echinocandin resistance with concomitant FKS1 mutations. The transmission of C. auris in this outbreak was linked to infected/colonized patients and the hospital environment. However, despite continuous surveillance and enforcement of infection control measures, sporadic new cases continued to occur, challenging the containment efforts. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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16 pages, 1527 KiB  
Article
Candida auris Direct Detection from Surveillance Swabs, Blood, and Urine Using a Laboratory-Developed PCR Method
by Robert C. Walchak, Seanne P. Buckwalter, Nicole M. Zinsmaster, Katrina M. Henn, Katelyn M. Johnson, Jolene M. Koelsch, Senait A. Herring, Lory K. Steinmetz, Katelyn A. Reed, Jean E. Barth, Jenna M. Rasmusson, Jill L. Fischer, Paula Snippes Vagnone, Priya Sampathkumar and Nancy L. Wengenack
J. Fungi 2020, 6(4), 224; https://0-doi-org.brum.beds.ac.uk/10.3390/jof6040224 - 15 Oct 2020
Cited by 10 | Viewed by 2724
Abstract
Candida auris is an emerging fungal pathogen with cases reported in countries around the world and in 19 states within the United States as of August 2020. The CDC has recommended that hospitals perform active surveillance upon admission for patients with the appropriate [...] Read more.
Candida auris is an emerging fungal pathogen with cases reported in countries around the world and in 19 states within the United States as of August 2020. The CDC has recommended that hospitals perform active surveillance upon admission for patients with the appropriate risk factors. Currently, active surveillance requires that local hospitals send surveillance swabs to a public health laboratory for analysis. In this work, a real-time PCR assay was developed for the specific detection of C. auris from surveillance swabs, blood, and urine to enable rapid detection of this pathogen. The assay uses commercially available primers and reporter probes and it was verified on the LightCycler 480 PCR platform. Contrived specimens and prospectively collected composite groin/axilla surveillance swabs were used to validate the assay. The performance of the PCR assay on surveillance swabs was also compared to a second PCR assay targeting C. auris that was performed at the Minnesota Department of Health–Public Health Laboratory (MDH-PHL). Our PCR assay is able to detect and differentiate C. auris from closely related Candida species such as C. duobushaemulonii, C. haemulonii, and C. pseudohaemulonii on the basis of melting curve temperature differences. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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19 pages, 908 KiB  
Article
Evaluation of Microsatellite Typing, ITS Sequencing, AFLP Fingerprinting, MALDI-TOF MS, and Fourier-Transform Infrared Spectroscopy Analysis of Candida auris
by Mansoureh Vatanshenassan, Teun Boekhout, Norman Mauder, Vincent Robert, Thomas Maier, Jacques F. Meis, Judith Berman, Euníce Then, Markus Kostrzewa and Ferry Hagen
J. Fungi 2020, 6(3), 146; https://0-doi-org.brum.beds.ac.uk/10.3390/jof6030146 - 25 Aug 2020
Cited by 22 | Viewed by 4330
Abstract
Candida auris is an emerging opportunistic yeast species causing nosocomial outbreaks at a global scale. A few studies have focused on the C. auris genotypic structure. Here, we compared five epidemiological typing tools using a set of 96 C. auris isolates from 14 [...] Read more.
Candida auris is an emerging opportunistic yeast species causing nosocomial outbreaks at a global scale. A few studies have focused on the C. auris genotypic structure. Here, we compared five epidemiological typing tools using a set of 96 C. auris isolates from 14 geographical areas. Isolates were analyzed by microsatellite typing, ITS sequencing, amplified fragment length polymorphism (AFLP) fingerprint analysis, matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS), and Fourier-transform infrared (FTIR) spectroscopy methods. Microsatellite typing grouped the isolates into four main clusters, corresponding to the four known clades in concordance with whole genome sequencing studies. The other investigated typing tools showed poor performance compared with microsatellite typing. A comparison between the five methods showed the highest agreement between microsatellite typing and ITS sequencing with 45% similarity, followed by microsatellite typing and the FTIR method with 33% similarity. The lowest agreement was observed between FTIR spectroscopy, MALDI-TOF MS, and ITS sequencing. This study indicates that microsatellite typing is the tool of choice for C. auris outbreak investigations. Additionally, FTIR spectroscopy requires further optimization and evaluation before it can be used as an epidemiological typing method, comparable with microsatellite typing, as a rapid method for tracing nosocomial fungal outbreaks. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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10 pages, 564 KiB  
Brief Report
SCA Medium: A New Culture Medium for the Isolation of All Candida auris Clades
by Ahmad Ibrahim, Lucie Peyclit, Rim Abdallah, Saber Khelaifia, Amanda Chamieh, Jean-Marc Rolain and Fadi Bittar
J. Fungi 2021, 7(6), 433; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7060433 - 29 May 2021
Cited by 8 | Viewed by 3363
Abstract
Candida auris is an emerging multidrug-resistant yeast causing nosocomial infections and associated with high mortality in immunocompromised patients. Rapid identification and characterisation are necessary for diagnosis and containing its spread. In this study, we present a selective culture medium for all C. auris [...] Read more.
Candida auris is an emerging multidrug-resistant yeast causing nosocomial infections and associated with high mortality in immunocompromised patients. Rapid identification and characterisation are necessary for diagnosis and containing its spread. In this study, we present a selective culture medium for all C. auris clades. This medium is sensitive with a limit of detection ranging between 101 and 102 CFU/mL. The 100% specificity of SCA (specific C. auris) medium is confirmed on a set of 135 Candida strains, 50 bacterial species and 200 human stool samples. Thus, this medium specifically selects for C. auris isolation from clinical samples, allowing the latter to study its phenotypic profile. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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6 pages, 741 KiB  
Case Report
Two Candida auris Cases in Germany with No Recent Contact to Foreign Healthcare—Epidemiological and Microbiological Investigations
by Joerg Steinmann, Thomas Schrauzer, Lisa Kirchhoff, Jacques F. Meis and Peter-Michael Rath
J. Fungi 2021, 7(5), 380; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7050380 - 12 May 2021
Cited by 7 | Viewed by 2840
Abstract
Candida auris has become a global fungal public health threat. This multidrug-resistant yeast is associated with nosocomial intra- and interhospital transmissions causing healthcare-associated infections. Here, we report on two C. auris cases from Germany. The two patients stayed in Germany for a long [...] Read more.
Candida auris has become a global fungal public health threat. This multidrug-resistant yeast is associated with nosocomial intra- and interhospital transmissions causing healthcare-associated infections. Here, we report on two C. auris cases from Germany. The two patients stayed in Germany for a long time before C. auris was detected during their hospitalization. The patients were isolated in single rooms with contact precautions. No nosocomial transmissions were detected within the hospital. Both C. auris isolates exhibited high minimum inhibitory concentrations (MICs) of fluconazole and one isolate additionally high MICs against the echinocandins. Microsatellite genotyping showed that both strains belong to the South Asian clade. These two cases are examples for appropriate in-hospital care and infection control without further nosocomial spread. Awareness for this emerging, multidrug-resistant pathogen is justified and systematic surveillance in European health care facilities should be performed. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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6 pages, 5971 KiB  
Brief Report
Emergence of Candida auris in Brazil in a COVID-19 Intensive Care Unit
by João N. de Almeida, Jr., Elaine C. Francisco, Ferry Hagen, Igor B. Brandão, Felicidade M. Pereira, Pedro H. Presta Dias, Magda M. de Miranda Costa, Regiane T. de Souza Jordão, Theun de Groot and Arnaldo L. Colombo
J. Fungi 2021, 7(3), 220; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7030220 - 17 Mar 2021
Cited by 58 | Viewed by 13224
Abstract
In December 2020, Candida auris emerged in Brazil in the city of Salvador. The first two C. auris colonized patients were in the same COVID-19 intensive care unit. Antifungal susceptibility testing showed low minimal inhibitory concentrations of 1 µg/mL, 2 µg/mL, 0.03 µg/L, [...] Read more.
In December 2020, Candida auris emerged in Brazil in the city of Salvador. The first two C. auris colonized patients were in the same COVID-19 intensive care unit. Antifungal susceptibility testing showed low minimal inhibitory concentrations of 1 µg/mL, 2 µg/mL, 0.03 µg/L, and 0.06 µg/mL for amphotericin B, fluconazole, voriconazole, and anidulafungin, respectively. Microsatellite typing revealed that the strains are clonal and belong to the South Asian clade C. auris. The travel restrictions during the COVID-19 pandemic and the absence of travel history among the colonized patients lead to the hypothesis that this species was introduced several months before the recognition of the first case and/or emerged locally in the coastline Salvador area. Full article
(This article belongs to the Special Issue Candida auris 2.0)
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