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Peng Y, Liu Y, Yu X, Fang J, Guo Z, Liao K, Chen P, Guo P. First report of Candida auris in Guangdong, China: clinical and microbiological characteristics of 7 episodes of candidemia. Emerg Microbes Infect 2024; 13:2300525. [PMID: 38164742 PMCID: PMC10773663 DOI: 10.1080/22221751.2023.2300525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
Candida auris is an emerging multidrug-resistant fungal pathogen worldwide. To date, it has not been reported in Guangdong, China. For the first time, we reported 7 cases of C. auris candidemia from two hospitals in Guangdong. The clinical and microbiological characteristics of these cases were investigated carefully. Two geographic clades, i.e. III and I, were found popular in different hospitals by whole genome sequencing analyses. All C. auris isolates from bloodstream were resistant to fluconazole, 5 of which belonged to Clade III harbouring VF125AL mutation in the ERG11 gene. The isolates with Clade I presented Y132F mutation in the ERG11 gene as well as resistance to amphotericin B. All isolates exhibited strong biofilm-forming capacity and non-aggregative phenotype. The mean time from admission to onset of C. auris candidemia was 39.4 days (range: 12 - 80 days). Despite performing appropriate therapeutic regimen, 42.9% (3/7) of patients experienced occurrences of C. auris candidemia and colonization after the first positive bloodstream. C. auris colonization was still observed after the first C. auris candidemia for 81 days in some patient. Microbiologic eradication from bloodstream was achieved in 85.7% (6/7) of patients at discharge. In conclusion, this study offers a crucial insight into unravelling the multiple origins of C. auris in Guangdong, highlighting great challenges in clinical prevention and control.
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Affiliation(s)
- Yaqin Peng
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yue Liu
- Department of Clinical Laboratory, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Xuegao Yu
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Jingchun Fang
- Department of Clinical Microbiology Laboratory, Nansha Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Zhaowang Guo
- Department of Clinical Laboratory, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Kang Liao
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Peisong Chen
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Penghao Guo
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
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Salama EA, Elgammal Y, Wijeratne A, Lanman NA, Utturkar SM, Farhangian A, Li J, Meunier B, Hazbun TR, Seleem MN. Lansoprazole interferes with fungal respiration and acts synergistically with amphotericin B against multidrug-resistant Candida auris. Emerg Microbes Infect 2024; 13:2322649. [PMID: 38431850 PMCID: PMC10911247 DOI: 10.1080/22221751.2024.2322649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
Candida auris has emerged as a problematic fungal pathogen associated with high morbidity and mortality. Amphotericin B (AmB) is the most effective antifungal used to treat invasive fungal candidiasis, with resistance rarely observed among clinical isolates. However, C. auris possesses extraordinary resistant profiles against all available antifungal drugs, including AmB. In our pursuit of potential solutions, we screened a panel of 727 FDA-approved drugs. We identified the proton pump inhibitor lansoprazole (LNP) as a potent enhancer of AmB's activity against C. auris. LNP also potentiates the antifungal activity of AmB against other medically important species of Candida and Cryptococcus. Our investigations into the mechanism of action unveiled that LNP metabolite(s) interact with a crucial target in the mitochondrial respiratory chain (complex III, known as cytochrome bc1). This interaction increases oxidative stress within fungal cells. Our results demonstrated the critical role of an active respiratory function in the antifungal activity of LNP. Most importantly, LNP restored the efficacy of AmB in an immunocompromised mouse model, resulting in a 1.7-log (∼98%) CFU reduction in the burden of C. auris in the kidneys. Our findings strongly advocate for a comprehensive evaluation of LNP as a cytochrome bc1 inhibitor for combating drug-resistant C. auris infections.
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Affiliation(s)
- Ehab A. Salama
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
- Center for One Health Research, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Yehia Elgammal
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
- Center for One Health Research, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Aruna Wijeratne
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nadia A. Lanman
- Purdue Institute for Cancer Research, Purdue University, West Lafayette, Indiana, USA
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, USA
| | - Sagar M. Utturkar
- Purdue Institute for Cancer Research, Purdue University, West Lafayette, Indiana, USA
| | - Atena Farhangian
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, USA
| | - Jianing Li
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, USA
| | - Brigitte Meunier
- Institute for Integrative Biology of the Cell (I2BC), Université Paris-Saclay, CEA, CNRS, Gif-sur-Yvette, France
| | - Tony R. Hazbun
- Purdue Institute for Cancer Research, Purdue University, West Lafayette, Indiana, USA
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, USA
| | - Mohamed N. Seleem
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
- Center for One Health Research, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
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Dakalbab S, Hamdy R, Holigová P, Abuzaid EJ, Abu-Qiyas A, Lashine Y, Mohammad MG, Soliman SSM. Uniqueness of Candida auris cell wall in morphogenesis, virulence, resistance, and immune evasion. Microbiol Res 2024; 286:127797. [PMID: 38851008 DOI: 10.1016/j.micres.2024.127797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/02/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
Candida auris has drawn global attention due to its alarming multidrug resistance and the emergence of pan resistant strains. C. auris poses a significant risk in nosocomial candidemia especially among immunocompromised patients. C. auris showed unique virulence characteristics associated with cell wall including cell polymorphism, adaptation, endurance on inanimate surfaces, tolerance to external conditions, and immune evasion. Notably, it possesses a distinctive cell wall composition, with an outer mannan layer shielding the inner 1,3-β glucan from immune recognition, thereby enabling immune evasion and drug resistance. This review aimed to comprehend the association between unique characteristics of C. auris's cell wall and virulence, resistance mechanisms, and immune evasion. This is particularly relevant since the fungal cell wall has no human homology, providing a potential therapeutic target. Understanding the complex interactions between the cell wall and the host immune system is essential for devising effective treatment strategies, such as the use of repurposed medications, novel therapeutic agents, and immunotherapy like monoclonal antibodies. This therapeutic targeting strategy of C. auris holds promise for effective eradication of this resilient pathogen.
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Affiliation(s)
- Salam Dakalbab
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box, Sharjah 27272, United Arab Emirates; College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Rania Hamdy
- Research Institute for Science and Engineering (RISE), University of Sharjah, Sharjah 27272, United Arab Emirates; Faculty of Pharmacy, Zagazig University, P.O. Box 44519, Egypt
| | | | - Eman J Abuzaid
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box, Sharjah 27272, United Arab Emirates
| | - Ameera Abu-Qiyas
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box, Sharjah 27272, United Arab Emirates
| | - Yasmina Lashine
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box, Sharjah 27272, United Arab Emirates; Faculty of Pharmacy, Zagazig University, P.O. Box 44519, Egypt
| | - Mohammad G Mohammad
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box, Sharjah 27272, United Arab Emirates; Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Sameh S M Soliman
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box, Sharjah 27272, United Arab Emirates; Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates.
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Long B, Lacy AJ, Koyfman A, Liang SY. Candida auris: A focused review for emergency clinicians. Am J Emerg Med 2024; 84:162-167. [PMID: 39137491 DOI: 10.1016/j.ajem.2024.07.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/25/2024] [Accepted: 07/28/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION Candida auris is an emerging pathogen and human health threat. However, diagnosis and treatment of fungal infection due to C. auris are challenging. OBJECTIVE This narrative review provides a focused overview of C. auris for the emergency clinician. DISCUSSION C. auris was first identified in 2009 and is currently present on all continents except Antarctica. C. auris possesses multiple genetic factors resulting in antimicrobial resistance, increased virulence and survival within the host, and environmental adaptation. It is readily transmitted from person to person and from the environment to a person, resulting in colonization. Infection may develop days to months following colonization, most commonly in those with immunocompromised state, significant comorbidities or other underlying conditions, healthcare exposure, and recent antimicrobial therapy. Candidemia, device infection (e.g., central venous catheter), soft tissue or wound infection, burn infection, osteomyelitis, myocarditis, meningitis, and urinary tract infection have been associated with C. auris. Samples should be obtained from the suspected site of infection for microbiological culture. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) with reference databases to differentiate C. auris from other species is optimal for diagnosis, though other molecular testing methods are available. Treatment is challenging due to antifungal resistance, with over 90% resistant to fluconazole. Echinocandins are most commonly used as the first line therapy. Prevention of colonization and infection are vital and include screening in high-risk populations and strict adherence to infection prevention practices with contact precautions and hand hygiene, as well as appropriate decontamination of patient areas. CONCLUSION An understanding of C. auris can assist emergency clinicians in the care of infected or colonized patients.
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Affiliation(s)
- Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, United States.
| | - Aaron J Lacy
- Division of Emergency Medicine Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, United States
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwester, Dallas, TX, United States
| | - Stephen Y Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, United States.
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Mulet-Bayona JV, Cancino-Muñoz I, Salvador-García C, Tormo-Palop N, Guna-Serrano MDR, Ferrer-Gómez C, Melero-García M, González-Candelas F, Gimeno-Cardona C. Genotypic and phenotypic characterisation of a nosocomial outbreak of Candida auris in Spain during 5 years. Mycoses 2024; 67:e13776. [PMID: 39086009 DOI: 10.1111/myc.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES The investigation of Candida auris outbreaks is needed to provide insights into its population structure and transmission dynamics. We genotypically and phenotypically characterised a C. auris nosocomial outbreak occurred in Consorcio Hospital General Universitario de Valencia (CHGUV), Spain. METHODS Data and isolates were collected from CHGUV from September 2017 (first case) until September 2021. Thirty-five isolates, including one from an environmental source, were randomly selected for whole genome sequencing (WGS), and the genomes were analysed along with a database with 335 publicly available genomes, assigning them to one of the five major clades. In order to identify polymorphisms associated with drug resistance, we used the fully susceptible GCA_003014415.1 strain as reference sequence. Known mutations in genes ERG11 and FKS1 conferring resistance to fluconazole and echinocandins, respectively, were investigated. Isolates were classified into aggregating or non-aggregating. RESULTS All isolates belonged to clade III and were from an outbreak with a single origin. They clustered close to three publicly available genomes from a hospital from where the first patient was transferred, being the probable origin. The mutation VF125AL in the ERG11 gene, conferring resistance to fluconazole, was present in all the isolates and one isolate also carried the mutation S639Y in the FKS1 gene. All the isolates had a non-aggregating phenotype (potentially more virulent). CONCLUSIONS Isolates are genotypically related and phenotypically identical but one with resistance to echinocandins, which seems to indicate that they all belong to an outbreak originated from a single isolate, remaining largely invariable over the years. This result stresses the importance of implementing infection control practices as soon as the first case is detected or when a patient is transferred from a setting with known cases.
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Affiliation(s)
- Juan Vicente Mulet-Bayona
- Servicio de Microbiología y Parasitología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Irving Cancino-Muñoz
- Unidad Mixta Infección y Salud Pública FISABIO-Universidad de Valencia, Valencia, Spain
- Instituto de Biología Integrativa de Sistemas, I2SysBio (CSIC-UV), Valencia, Spain
| | - Carme Salvador-García
- Servicio de Microbiología y Parasitología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Nuria Tormo-Palop
- Servicio de Microbiología y Parasitología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - María Del Remedio Guna-Serrano
- Servicio de Microbiología y Parasitología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
- Departamento de Microbiología y Ecología, Universidad de Valencia, Valencia, Spain
| | - Carolina Ferrer-Gómez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Mercedes Melero-García
- Servicio de Medicina Preventiva, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Fernando González-Candelas
- Unidad Mixta Infección y Salud Pública FISABIO-Universidad de Valencia, Valencia, Spain
- Instituto de Biología Integrativa de Sistemas, I2SysBio (CSIC-UV), Valencia, Spain
- CIBER en Epidemiología y Salud Pública, ISCIII, Madrid, Spain
| | - Concepción Gimeno-Cardona
- Servicio de Microbiología y Parasitología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
- Departamento de Microbiología y Ecología, Universidad de Valencia, Valencia, Spain
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Suphavilai C, Ko KKK, Lim KM, Tan MG, Boonsimma P, Chu JJK, Goh SS, Rajandran P, Lee LC, Tan KY, Shaik Ismail BB, Aung MK, Yang Y, Sim JXY, Venkatachalam I, Cherng BPZ, Spruijtenburg B, Chan KS, Oon LLE, Tan AL, Tan YE, Wijaya L, Tan BH, Ling ML, Koh TH, Meis JF, Tsui CKM, Nagarajan N. Detection and characterisation of a sixth Candida auris clade in Singapore: a genomic and phenotypic study. THE LANCET. MICROBE 2024:S2666-5247(24)00101-0. [PMID: 39008997 DOI: 10.1016/s2666-5247(24)00101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/04/2024] [Accepted: 04/09/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND The emerging fungal pathogen Candida auris poses a serious threat to global public health due to its worldwide distribution, multidrug resistance, high transmissibility, propensity to cause outbreaks, and high mortality. We aimed to characterise three unusual C auris isolates detected in Singapore, and to determine whether they constitute a novel clade distinct from all previously known C auris clades (I-V). METHODS In this genotypic and phenotypic study, we characterised three C auris clinical isolates, which were cultured from epidemiologically unlinked inpatients at a large tertiary hospital in Singapore. The index isolate was detected in April, 2023. We performed whole-genome sequencing (WGS) and obtained hybrid assemblies of these C auris isolates. The complete genomes were compared with representative genomes of all known C auris clades. To provide a global context, 3651 international WGS data from the National Center for Biotechnology Information (NCBI) database were included in a high-resolution single nucleotide polymorphism (SNP) analysis. Antifungal susceptibility testing was done and antifungal resistance genes, mating-type locus, and chromosomal rearrangements were characterised from the WGS data of the three investigated isolates. We further implemented Bayesian logistic regression models to classify isolates into known clades and simulate the automatic detection of isolates belonging to novel clades as their WGS data became available. FINDINGS The three investigated isolates were separated by at least 37 000 SNPs (range 37 000-236 900) from all existing C auris clades. These isolates had opposite mating-type allele and different chromosomal rearrangements when compared with their closest clade IV relatives. The isolates were susceptible to all tested antifungals. Therefore, we propose that these isolates represent a new clade of C auris, clade VI. Furthermore, an independent WGS dataset from Bangladesh, accessed via the NCBI Sequence Read Archive, was found to belong to this new clade. As a proof-of-concept, our Bayesian logistic regression model was able to flag these outlier genomes as a potential new clade. INTERPRETATION The discovery of a new C auris clade in Singapore and Bangladesh in the Indomalayan zone, showing a close relationship to clade IV members most commonly found in South America, highlights the unknown genetic diversity and origin of C auris, particularly in under-resourced regions. Active surveillance in clinical settings, along with effective sequencing strategies and downstream analysis, will be essential in the identification of novel strains, tracking of transmission, and containment of adverse clinical effects of C auris infections. FUNDING Duke-NUS Academic Medical Center Nurturing Clinician Researcher Scheme, and the Genedant-GIS Innovation Program.
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Affiliation(s)
- Chayaporn Suphavilai
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Karrie Kwan Ki Ko
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore; Department of Microbiology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Kar Mun Lim
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Mei Gie Tan
- Department of Microbiology, Singapore General Hospital, Singapore
| | - Patipan Boonsimma
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Joash Jun Keat Chu
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Sui Sin Goh
- Department of Microbiology, Singapore General Hospital, Singapore
| | | | - Lai Chee Lee
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Kwee Yuen Tan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | | | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Yong Yang
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Jean Xiang Ying Sim
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Indumathi Venkatachalam
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Benjamin Pei Zhi Cherng
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Bram Spruijtenburg
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands; Center of Expertise in Mycology of Radboud University Medical Center, Nijmegen, Netherlands
| | - Kian Sing Chan
- Department of Microbiology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Lynette Lin Ean Oon
- Department of Microbiology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Ai Ling Tan
- Department of Microbiology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Yen Ee Tan
- Department of Microbiology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Limin Wijaya
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Tse Hsien Koh
- Department of Microbiology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands; Center of Expertise in Mycology of Radboud University Medical Center, Nijmegen, Netherlands; Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
| | - Clement Kin Ming Tsui
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Niranjan Nagarajan
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Fayed B, Shakartalla SB, Sabbah H, Dalle H, Tannira M, Senok A, Soliman SSM. Transcriptome Analysis of Human Dermal Cells Infected with Candida auris Identified Unique Pathogenesis/Defensive Mechanisms Particularly Ferroptosis. Mycopathologia 2024; 189:65. [PMID: 38990436 DOI: 10.1007/s11046-024-00868-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 06/10/2024] [Indexed: 07/12/2024]
Abstract
Candida auris is an emerging multi-drug resistant yeast that can cause life-threatening infections. A recent report clarified the ability of C. auris to form a biofilm with enhanced drug resistance properties in the host skin's deep layers. The formed biofilm may initiate further bloodstream spread and immune escape. Therefore, we propose that secreted chemicals from the biofilm may facilitate fungal pathogenesis. In response to this interaction, the host skin may develop potential defensive mechanisms. Comparative transcriptomics was performed on the host dermal cells in response to indirect interaction with C. auris biofilm through Transwell inserts compared to planktonic cells. Furthermore, the effect of antifungals including caspofungin and fluconazole was studied. The obtained data showed that the dermal cells exhibited different transcriptional responses. Kyoto Encyclopedia of Genes and Genomes and Reactome analyses identified potential defensive responses employed by the dermal cells and potential toxicity induced by C. auris. Additionally, our data indicated that the dominating toxic effect was mediated by ferroptosis; which was validated by qRT-PCR, cytotoxicity assay, and flow cytometry. On the other hand, the viability of C. auris biofilm was enhanced and accompanied by upregulation of MDR1, and KRE6 upon interaction with dermal cells; both genes play significant roles in drug resistance and biofilm maturation, respectively. This study for the first-time shed light on the dominating defensive responses of human dermal cells, microbe colonization site, to C. auris biofilm and its toxic effects. Further, it demonstrates how C. auris biofilm responds to the defensive mechanisms developed by the human dermal cells.
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Affiliation(s)
- Bahgat Fayed
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
- Chemistry of Natural and Microbial Products, National Research Centre, Cairo, Egypt
| | - Sarra B Shakartalla
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
- College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, UAE
- Faculty of Pharmacy, University of Gezira, P.O.Box. 21111, Wad Medani, Sudan
| | - Hassan Sabbah
- AbbVie BioPharmaceuticals, P.O. Box 118052, Dubai, UAE
| | - Hala Dalle
- AbbVie BioPharmaceuticals, Kuwait City, Kuwait
| | | | - Abiola Senok
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14 Dubai Healthcare City, P.O.Box 505055, Dubai, UAE
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE.
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE.
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8
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Poulopoulou A, Sidiropoulou A, Sarmourli T, Zachrou E, Michailidou C, Zarras C, Vagdatli E, Massa E, Mouloudi E, Pyrpasopoulou A, Meletis G, Protonotariou E, Skoura L, Metallidis S, Karampatakis T, Katsifa E, Nikopoulou A, Louka A, Rizou A, Arvaniti K, Kouvelis V, Borman A, Roilides E, Vyzantiadis TA. Candida auris: Outbreak, surveillance and epidemiological monitoring in Northern Greece. Med Mycol 2024; 62:myae062. [PMID: 38877671 PMCID: PMC11232515 DOI: 10.1093/mmy/myae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/21/2024] [Accepted: 06/13/2024] [Indexed: 06/16/2024] Open
Abstract
Candida auris is an emerging fungal pathogen associated with multi-drug resistance rates and widespread outbreaks in hospitals and healthcare units worldwide. Sequencing studies have revealed that different clonal lineages of the fungus seem to be prevalent among distinct geographical sites. The first case of C. auris in Northern Greece was reported in Thessaloniki in October 2022, almost 2 years after the first isolation in Greece (Athens 2019). The Mycology Laboratory of the Medical School of Aristotle University of Thessaloniki stands as the reference laboratory for fungal diseases in Northern Greece and a meticulous search for the yeast, in plenty of suspicious samples, has been run since 2019 in the Lab as well as a retrospective analysis of all its yeasts' collection, back to 2008, with negative results for the presence of C. auris. Here, are presented the findings concerning the outbreak and surveillance of C. auris in Northern Greece, mainly the region of Thessaloniki and the broader area of Macedonia, from October 2022 until August 2023. The isolates from Northern Greece continue to fall in Clade I and present with an almost equal and stable sensitivity profile until now.
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Affiliation(s)
- Aikaterina Poulopoulou
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124, Greece
| | - Anna Sidiropoulou
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124, Greece
| | - Theopisti Sarmourli
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124, Greece
| | - Evaggelia Zachrou
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124, Greece
| | - Chrysi Michailidou
- Department of Biopathology, Hippokratio General Hospital, Thessaloniki 54642, Greece
| | - Charalampos Zarras
- Department of Biopathology, Hippokratio General Hospital, Thessaloniki 54642, Greece
| | - Eleni Vagdatli
- Department of Biopathology, Hippokratio General Hospital, Thessaloniki 54642, Greece
| | - Eleni Massa
- ICU, Hippokratio General Hospital, Thessaloniki 54642, Greece
| | - Eleni Mouloudi
- ICU, Hippokratio General Hospital, Thessaloniki 54642, Greece
| | - Athina Pyrpasopoulou
- Infectious Diseases Unit, Hippokratio General Hospital, Thessaloniki 54642, Greece
| | - Georgios Meletis
- Department of Microbiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636, Greece
| | - Efthymia Protonotariou
- Department of Microbiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636, Greece
| | - Lemonia Skoura
- Department of Microbiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636, Greece
| | - Simeon Metallidis
- First Department of Internal Medicine, Infectious Diseases Division, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636, Greece
| | - Theodoros Karampatakis
- Department of Microbiology, G. Papanikolaou General Hospital, Thessaloniki 57010, Greece
| | - Eleni Katsifa
- Department of Microbiology, G. Papanikolaou General Hospital, Thessaloniki 57010, Greece
| | - Anna Nikopoulou
- Infectious Disease Unit, G. Papanikolaou General Hospital, Thessaloniki 57010, Greece
| | - Alexandra Louka
- Department of Microbiology, Mamatsio General Hospital, Kozani 50100, Greece
| | - Artemisia Rizou
- Department of Microbiology, Mamatsio General Hospital, Kozani 50100, Greece
| | | | - Vassili Kouvelis
- Section of Genetics & Biotechnology, Department of Biology, National & Kapodistrian University of Athens, 15772, Greece
| | - Andrew Borman
- Mycology Reference Laboratory, UK Health Security Agency, Southmead Hospital, Bristol BS10 5NB, UK
| | - Emmanuel Roilides
- Infectious Diseases Unit, Hippokratio General Hospital, Thessaloniki 54642, Greece
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9
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Khan T, Faysal NI, Hossain MM, Mah-E-Muneer S, Haider A, Moon SB, Sen D, Ahmed D, Parnell LA, Jubair M, Chow NA, Chowdhury F, Rahman M. Emergence of the novel sixth Candida auris Clade VI in Bangladesh. Microbiol Spectr 2024; 12:e0354023. [PMID: 38842332 PMCID: PMC11218448 DOI: 10.1128/spectrum.03540-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/15/2024] [Indexed: 06/07/2024] Open
Abstract
Candida auris, initially identified in 2009, has rapidly become a critical concern due to its antifungal resistance and significant mortality rates in healthcare-associated outbreaks. To date, whole-genome sequencing (WGS) has identified five unique clades of C. auris, with some strains displaying resistance to all primary antifungal drug classes. In this study, we presented the first WGS analysis of C. auris from Bangladesh, describing its origins, transmission dynamics, and antifungal susceptibility testing (AFST) profile. Ten C. auris isolates collected from hospital settings in Bangladesh were initially identified by CHROMagar Candida Plus, followed by VITEK2 system, and later sequenced using Illumina NextSeq 550 system. Reference-based phylogenetic analysis and variant calling pipelines were used to classify the isolates in different clades. All isolates aligned ~90% with the Clade I C. auris B11205 reference genome. Of the 10 isolates, 8 were clustered with Clade I isolates, highlighting a South Asian lineage prevalent in Bangladesh. Remarkably, the remaining two isolates formed a distinct cluster, exhibiting >42,447 single-nucleotide polymorphism differences compared to their closest Clade IV counterparts. This significant variation corroborates the emergence of a sixth clade (Clade VI) of C. auris in Bangladesh, with potential for international transmission. AFST results showed that 80% of the C. auris isolates were resistant to fluconazole and voriconazole, whereas Clade VI isolates were susceptible to azoles, echinocandins, and pyrimidine analogue. Genomic sequencing revealed ERG11_Y132F mutation conferring azole resistance while FCY1_S70R mutation found inconsequential in describing 5-flucytosine resistance. Our study underscores the pressing need for comprehensive genomic surveillance in Bangladesh to better understand the emergence, transmission dynamics, and resistance profiles of C. auris infections. Unveiling the discovery of a sixth clade (Clade VI) accentuates the indispensable role of advanced sequencing methodologies.IMPORTANCECandida auris is a nosocomial fungal pathogen that is commonly misidentified as other Candida species. Since its emergence in 2009, this multidrug-resistant fungus has become one of the five urgent antimicrobial threats by 2019. Whole-genome sequencing (WGS) has proven to be the most accurate identification technique of C. auris which also played a crucial role in the initial discovery of this pathogen. WGS analysis of C. auris has revealed five distinct clades where isolates of each clade differ among themselves based on pathogenicity, colonization, infection mechanism, as well as other phenotypic characteristics. In Bangladesh, C. auris was first reported in 2019 from clinical samples of a large hospital in Dhaka city. To understand the origin, transmission dynamics, and antifungal-resistance profile of C. auris isolates circulating in Bangladesh, we conducted a WGS-based surveillance study on two of the largest hospital settings in Dhaka, Bangladesh.
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Affiliation(s)
- Tahsin Khan
- Genome Center, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | | | | | - Syeda Mah-E-Muneer
- Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Arefeen Haider
- Genome Center, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Shovan Basak Moon
- Genome Center, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Debashis Sen
- Mycology Laboratory, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Dilruba Ahmed
- Mycology Laboratory, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Lindsay A Parnell
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mohammad Jubair
- Genome Center, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Nancy A Chow
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fahmida Chowdhury
- Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Mustafizur Rahman
- Genome Center, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
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10
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Patwardhan SA, Prayag PS, Soman RN, Purandare BD, Ramya S, Dawra R, Joshi R, Prayag AP. Candida auris - Comparison of sensititre YeastOne and Vitek 2 AST systems for antifungal susceptibility testing - A single centre experience. Indian J Med Microbiol 2024; 50:100618. [PMID: 38795936 DOI: 10.1016/j.ijmmb.2024.100618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Candida auris is emerging as an important cause of candidemia and deep seated candidal infection. We compared the susceptibility results of bloodstream Candida auris isolates by Vitek 2 with Sensititre YeastOne (SYO) method. METHODS Forty-seven C. auris blood stream isolates were simultaneously tested for AFST by Vitek 2 and SYO. RESULTS All strains were resistant to Fluconazole. 25.5% isolates showed pan-azole resistance. In comparison with SYO, lower MICs for voriconazole were noted with Vitek 2 (VME rate 76.1%). All strains were sensitive to anidulafungin and micafungin by SYO. For micafungin, Vitek 2 demonstrated higher MICs and an ME rate of 23.5%. Susceptibility interpretation of caspofungin by SYO was challenged by development of 'Eagle effect' resulting in sensitivity of 28.2%. We studied the evolution of caspofungin 'Eagle effect' with SYO by serial hourly MIC readings and noted that paradoxical growth commenced at 21 hrs of incubation. Compared to SYO, Vitek 2 showed higher resistance rate to Amphotericin B with ME rate of 25.6%. CONCLUSION Laboratories using commercial AFST systems for Candida auris need to be aware of the possibility of ME and VME for amphotericin B and voriconazole respectively with Vitek 2 and 'Eagle effect' for caspofungin with SYO.
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Affiliation(s)
| | - Parikshit S Prayag
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India.
| | - Rajeev N Soman
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India.
| | - Bharat D Purandare
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India.
| | - S Ramya
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India.
| | - Romika Dawra
- Department of Microbiology, Deenanath Mangeshkar Hospital, Pune, India.
| | - Rasika Joshi
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India.
| | - Amrita P Prayag
- Department of In-house Research, Deenanath Mangeshkar Hospital, Pune, India.
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11
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Kim HY, Nguyen TA, Kidd S, Chambers J, Alastruey-Izquierdo A, Shin JH, Dao A, Forastiero A, Wahyuningsih R, Chakrabarti A, Beyer P, Gigante V, Beardsley J, Sati H, Morrissey CO, Alffenaar JW. Candida auris-a systematic review to inform the world health organization fungal priority pathogens list. Med Mycol 2024; 62:myae042. [PMID: 38935900 PMCID: PMC11210622 DOI: 10.1093/mmy/myae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/15/2024] [Accepted: 04/29/2024] [Indexed: 06/29/2024] Open
Abstract
The World Health Organization (WHO) in 2022 developed a fungal priority pathogen list. Candida auris was ultimately ranked as a critical priority pathogen. PubMed and Web of Science were used to find studies published from 1 January 2011 to 18 February 2021, reporting on predefined criteria including: mortality, morbidity (i.e., hospitalization and disability), drug resistance, preventability, yearly incidence, and distribution/emergence. Thirty-seven studies were included in the final analysis. The overall and 30-day mortality rates associated with C. auris candidaemia ranged from 29% to 62% and 23% to 67%, respectively. The median length of hospital stay was 46-68 days, ranging up to 140 days. Late-onset complications of C. auris candidaemia included metastatic septic complications. Resistance rates to fluconazole were as high as 87%-100%. Susceptibility to isavuconazole, itraconazole, and posaconazole varied with MIC90 values of 0.06-1.0 mg/l. Resistance rates to voriconazole ranged widely from 28% to 98%. Resistance rates ranged between 8% and 35% for amphotericin B and 0%-8% for echinocandins. Over the last ten years, outbreaks due to C. auris have been reported in in all WHO regions. Given the outbreak potential of C. auris, the emergence and spread of MDR strains, and the challenges associated with its identification, and eradication of its environmental sources in healthcare settings, prevention and control measures based on the identified risk factors should be evaluated for their effectiveness and feasibility. Global surveillance studies could better inform the incidence rates and distribution patterns to evaluate the global burden of C. auris infections.
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Affiliation(s)
- Hannah Yejin Kim
- Sydney Infectious Disease Institute, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Hospital, NSW Health, Westmead, New South Wales, Australia
| | - Thi Anh Nguyen
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, Microbiology and Infectious Diseases, SA Pathology, Adelaide, South Australia, Australia
| | - Joshua Chambers
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Jong-Hee Shin
- Chonnam National University Medical School, Gwangju, Korea
| | - Aiken Dao
- Sydney Infectious Disease Institute, The University of Sydney, Sydney, NSW, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| | - Agustina Forastiero
- Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization (PAHO/WHO), Washington, DC, United States of America
| | - Retno Wahyuningsih
- Department of Parasitology, Division of Mycology, Faculty of Medicine of the Universitas Indonesia and Universitas Kristen Indonesia, Jakarta, Indonesia
| | | | | | | | - Justin Beardsley
- Sydney Infectious Disease Institute, The University of Sydney, Sydney, NSW, Australia
- Westmead Hospital, NSW Health, Westmead, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| | | | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
- Monash University, Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Jan-Willem Alffenaar
- Sydney Infectious Disease Institute, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Hospital, NSW Health, Westmead, New South Wales, Australia
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12
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de Paiva Macedo J, Dias VC. Antifungal resistance: why are we losing this battle? Future Microbiol 2024; 19:1027-1040. [PMID: 38904325 PMCID: PMC11318685 DOI: 10.1080/17460913.2024.2342150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/09/2024] [Indexed: 06/22/2024] Open
Abstract
The emergence of fungal pathogens and changes in the epidemiological landscape are prevalent issues in clinical mycology. Reports of resistance to antifungals have been reported. This review aims to evaluate molecular and nonmolecular mechanisms related to antifungal resistance. Mutations in the ERG genes and overexpression of the efflux pump (MDR1, CDR1 and CDR2 genes) were the most reported molecular mechanisms of resistance in clinical isolates, mainly related to Azoles. For echinocandins, a molecular mechanism described was mutation in the FSK genes. Furthermore, nonmolecular virulence factors contributed to therapeutic failure, such as biofilm formation and selective pressure due to previous exposure to antifungals. Thus, there are many public health challenges in treating fungal infections.
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Affiliation(s)
- Jamile de Paiva Macedo
- Master's Student in Biological Science, Federal University of Juiz de Fora – UFJF Rua José Lourenço Kelmer, s/n, São Pedro, Juiz de Fora, MG 36036 900, Brazil
| | - Vanessa Cordeiro Dias
- Department of Parasitology, Microbiology & Immunology Federal University of Juiz de Fora – UFJF Rua José Lourenço Kelmer, s/n, São Pedro, Juiz de Fora, MG 36036 900, Brazil
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13
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Kowalczyk A. Essential Oils against Candida auris-A Promising Approach for Antifungal Activity. Antibiotics (Basel) 2024; 13:568. [PMID: 38927234 PMCID: PMC11200742 DOI: 10.3390/antibiotics13060568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
The emergence of Candida auris as a multidrug-resistant fungal pathogen represents a significant global health challenge, especially given the growing issue of antifungal drug resistance. This review aims to illuminate the potential of essential oils (EOs), which are volatile plant secretions containing complex mixtures of chemicals, as alternative antifungal agents to combat C. auris, thus combining traditional insights with contemporary scientific findings to address this critical health issue. A systematic literature review was conducted using the PubMed, Scopus, and Web of Science databases from 2019 to 2024, and using the Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol to identify relevant studies on the antifungal efficacy of EOs or their components against C. auris. Of the 90 articles identified, 16 were selected for detailed review. The findings highlight the diverse mechanisms of action of EOs and their components, such as disrupting fungal cell membranes, inducing the production of reactive oxygen species (ROS), and impeding biofilm formation, suggesting that some of them may be as effective as, or better than, traditional antifungal drugs while potentially limiting the development of resistance. However, issues such as variability in the composition of EOs and a paucity of clinical trials have been identified as significant obstacles. In conclusion, EOs and their active ingredients are emerging as viable candidates for creating effective treatments for C. auris, underscoring their importance as alternative or complementary antifungal agents in the face of increasing drug resistance. The call for future research underscores the need for clinical trials and standardization to unlock the full antifungal potential of EOs against C. auris.
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Affiliation(s)
- Adam Kowalczyk
- Department of Pharmacognosy and Herbal Medicines, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wrocław, Poland
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14
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Osaigbovo II, Ekeng BE, Davies AA, Ebeigbe E, Bongomin F, Kanyua A, Revathi G, Oladele RO. Candida auris: A Systematic Review of a Globally Emerging Fungal Pathogen in Africa. Open Forum Infect Dis 2024; 11:ofad681. [PMID: 38887473 PMCID: PMC11181182 DOI: 10.1093/ofid/ofad681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/22/2023] [Indexed: 06/20/2024] Open
Abstract
Candida auris is a World Health Organization critical priority fungal pathogen. We conducted a systematic review to describe its epidemiology in Africa. PubMed and Google scholar databases were searched between January 2009 and September 2023 for clinical studies on C. auris cases and/or isolates from Africa. Reviews were excluded. We included 19 studies, involving at least 2529 cases from 6 African countries with the most, 2372 (93.8%), reported from South Africa. Whole-genome sequencing of 127 isolates identified 100 (78.7%) as clade III. Among 527 isolates, 481 (91.3%) were resistant to fluconazole, 108 (20.5%) to amphotericin B, and 9 (1.7%) to micafungin. Ninety of 211 (42.7%) patients with clinical outcomes died. C. auris is associated with high mortality and antifungal resistance, yet this critical pathogen remains underreported in Africa. Collaborative surveillance, fungal diagnostics, antifungals, and sustainable infection control practices are urgently needed for containment.
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Affiliation(s)
- Iriagbonse I Osaigbovo
- Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, Benin City, Nigeria
- Department of Medical Microbiology, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Bassey E Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Adeyinka A Davies
- Department of Medical Microbiology and Parasitology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Ejime Ebeigbe
- Department of Medical Microbiology, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alice Kanyua
- Department of Pathology and Laboratory Medicine, Aga Khan University, Nairobi, Kenya
| | - Gunturu Revathi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Nairobi, Kenya
| | - Rita O Oladele
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
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15
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Casimiro-Ramos A, Bautista-Crescencio C, Vidal-Montiel A, González GM, Hernández-García JA, Hernández-Rodríguez C, Villa-Tanaca L. Comparative Genomics of the First Resistant Candida auris Strain Isolated in Mexico: Phylogenomic and Pan-Genomic Analysis and Mutations Associated with Antifungal Resistance. J Fungi (Basel) 2024; 10:392. [PMID: 38921378 PMCID: PMC11204476 DOI: 10.3390/jof10060392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/19/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Candida auris is an emerging multidrug-resistant and opportunistic pathogenic yeast. Whole-genome sequencing analysis has defined five major clades, each from a distinct geographic region. The current study aimed to examine the genome of the C. auris 20-1498 strain, which is the first isolate of this fungus identified in Mexico. Based on whole-genome sequencing, the draft genome was found to contain 70 contigs. It had a total genome size of 12.86 Mbp, an N50 value of 1.6 Mbp, and an average guanine-cytosine (GC) content of 45.5%. Genome annotation revealed a total of 5432 genes encoding 5515 proteins. According to the genomic analysis, the C. auris 20-1498 strain belongs to clade IV (containing strains endemic to South America). Of the two genes (ERG11 and FKS1) associated with drug resistance in C. auris, a mutation was detected in K143R, a gene located in a mutation hotspot of ERG11 (lanosterol 14-α-demethylase), an antifungal drug target. The focus on whole-genome sequencing and the identification of mutations linked to the drug resistance of fungi could lead to the discovery of new therapeutic targets and new antifungal compounds.
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Affiliation(s)
- Arturo Casimiro-Ramos
- Laboratorio de Biología Molecular de Bacterias y Levaduras, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala, Casco de Santo Tomás, Ciudad de México 11340, Mexico; (A.C.-R.); (C.B.-C.); (A.V.-M.); (J.A.H.-G.); (C.H.-R.)
| | - Celia Bautista-Crescencio
- Laboratorio de Biología Molecular de Bacterias y Levaduras, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala, Casco de Santo Tomás, Ciudad de México 11340, Mexico; (A.C.-R.); (C.B.-C.); (A.V.-M.); (J.A.H.-G.); (C.H.-R.)
| | - Alvaro Vidal-Montiel
- Laboratorio de Biología Molecular de Bacterias y Levaduras, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala, Casco de Santo Tomás, Ciudad de México 11340, Mexico; (A.C.-R.); (C.B.-C.); (A.V.-M.); (J.A.H.-G.); (C.H.-R.)
| | - Gloria M. González
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio Gonzalez”, Av. Madero y Calle Dr. Eduardo Aguirre Pequeño s/n, Colonia Mitras Centro, Monterrey 64460, Nuevo Leon, Mexico;
| | - Juan Alfredo Hernández-García
- Laboratorio de Biología Molecular de Bacterias y Levaduras, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala, Casco de Santo Tomás, Ciudad de México 11340, Mexico; (A.C.-R.); (C.B.-C.); (A.V.-M.); (J.A.H.-G.); (C.H.-R.)
| | - César Hernández-Rodríguez
- Laboratorio de Biología Molecular de Bacterias y Levaduras, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala, Casco de Santo Tomás, Ciudad de México 11340, Mexico; (A.C.-R.); (C.B.-C.); (A.V.-M.); (J.A.H.-G.); (C.H.-R.)
| | - Lourdes Villa-Tanaca
- Laboratorio de Biología Molecular de Bacterias y Levaduras, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala, Casco de Santo Tomás, Ciudad de México 11340, Mexico; (A.C.-R.); (C.B.-C.); (A.V.-M.); (J.A.H.-G.); (C.H.-R.)
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16
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Izadi A, Paknia F, Roostaee M, Mousavi SAA, Barani M. Advancements in nanoparticle-based therapies for multidrug-resistant candidiasis infections: a comprehensive review. NANOTECHNOLOGY 2024; 35:332001. [PMID: 38749415 DOI: 10.1088/1361-6528/ad4bed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
Candida auris, a rapidly emerging multidrug-resistant fungal pathogen, poses a global health threat, with cases reported in over 47 countries. Conventional detection methods struggle, and the increasing resistance ofC. auristo antifungal agents has limited treatment options. Nanoparticle-based therapies, utilizing materials like silver, carbon, zinc oxide, titanium dioxide, polymer, and gold, show promise in effectively treating cutaneous candidiasis. This review explores recent advancements in nanoparticle-based therapies, emphasizing their potential to revolutionize antifungal therapy, particularly in combatingC. aurisinfections. The discussion delves into mechanisms of action, combinations of nanomaterials, and their application against multidrug-resistant fungal pathogens, offering exciting prospects for improved clinical outcomes and reduced mortality rates. The aim is to inspire further research, ushering in a new era in the fight against multidrug-resistant fungal infections, paving the way for more effective and targeted therapeutic interventions.
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Affiliation(s)
- Alireza Izadi
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
- Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Paknia
- Department of Nanobiotechnology, Faculty of Biological Sciences, Tarbiat Modares University, Tehran 14115-154, Iran
| | - Maryam Roostaee
- Department of Chemistry, Faculty of Sciences, Vali-e-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Seyed Amin Ayatollahi Mousavi
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
- Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahmood Barani
- Department of Chemistry, Faculty of Nano and Bio Science and Technology, Persian Gulf University, Bushehr 75168, Iran
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17
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Areitio M, Antoran A, Rodriguez-Erenaga O, Aparicio-Fernandez L, Martin-Souto L, Buldain I, Zaldibar B, Ruiz-Gaitan A, Pemán J, Rementeria A, Ramirez-Garcia A. Identification of the Most Immunoreactive Antigens of Candida auris to IgGs from Systemic Infections in Mice. J Proteome Res 2024; 23:1634-1648. [PMID: 38572994 PMCID: PMC11077488 DOI: 10.1021/acs.jproteome.3c00752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024]
Abstract
The delay in making a correct diagnosis of Candida auris causes concern in the healthcare system setting, and immunoproteomics studies are important to identify immunoreactive proteins for new diagnostic strategies. In this study, immunocompetent murine systemic infections caused by non-aggregative and aggregative phenotypes of C. auris and by Candida albicans and Candida haemulonii were carried out, and the obtained sera were used to study their immunoreactivity against C. auris proteins. The results showed higher virulence, in terms of infection signs, weight loss, and histopathological damage, of the non-aggregative isolate. Moreover, C. auris was less virulent than C. albicans but more than C. haemulonii. Regarding the immunoproteomics study, 13 spots recognized by sera from mice infected with both C. auris phenotypes and analyzed by mass spectrometry corresponded to enolase, phosphoglycerate kinase, glyceraldehyde-3-phosphate dehydrogenase, and phosphoglycerate mutase. These four proteins were also recognized by sera obtained from human patients with disseminated C. auris infection but not by sera obtained from mice infected with C. albicans or Aspergillus fumigatus. Spot identification data are available via ProteomeXchange with the identifier PXD049077. In conclusion, this study showed that the identified proteins could be potential candidates to be studied as new diagnostic or even therapeutic targets for C. auris.
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Affiliation(s)
- Maialen Areitio
- Department
of Immunology, Microbiology and Parasitology, Faculty of Science and
Technology, University of the Basque Country
(UPV/EHU), 48940 Leioa, Spain
| | - Aitziber Antoran
- Department
of Immunology, Microbiology and Parasitology, Faculty of Science and
Technology, University of the Basque Country
(UPV/EHU), 48940 Leioa, Spain
| | - Oier Rodriguez-Erenaga
- Department
of Immunology, Microbiology and Parasitology, Faculty of Science and
Technology, University of the Basque Country
(UPV/EHU), 48940 Leioa, Spain
| | - Leire Aparicio-Fernandez
- Department
of Immunology, Microbiology and Parasitology, Faculty of Science and
Technology, University of the Basque Country
(UPV/EHU), 48940 Leioa, Spain
| | - Leire Martin-Souto
- Department
of Immunology, Microbiology and Parasitology, Faculty of Science and
Technology, University of the Basque Country
(UPV/EHU), 48940 Leioa, Spain
| | - Idoia Buldain
- Department
of Immunology, Microbiology and Parasitology, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), 01006 Vitoria-Gasteiz, Spain
| | - Beñat Zaldibar
- CBET
Research Group, Department of Zoology and Animal Cell Biology, Faculty
of Science and Technology, Research Centre for Experimental Marine
Biology and Biotechnology PIE, University
of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Alba Ruiz-Gaitan
- Microbiology
Department, University and Polytechnic La
Fe Hospital, 46026 Valencia, Spain
| | - Javier Pemán
- Microbiology
Department, University and Polytechnic La
Fe Hospital, 46026 Valencia, Spain
| | - Aitor Rementeria
- Department
of Immunology, Microbiology and Parasitology, Faculty of Science and
Technology, University of the Basque Country
(UPV/EHU), 48940 Leioa, Spain
| | - Andoni Ramirez-Garcia
- Department
of Immunology, Microbiology and Parasitology, Faculty of Science and
Technology, University of the Basque Country
(UPV/EHU), 48940 Leioa, Spain
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Erkose Genc G, Caklovica Kucukkaya I, Komec S, Toker Onder I, Toptas O, Teke L, Turan D, Aygun G, Gulmez D, Arikan Akdagli S, Erturan Z. Evaluation of the first Candida auris isolates reported from Türkiye in terms of identification by various methods and susceptibility to antifungal drugs. Indian J Med Microbiol 2024; 49:100594. [PMID: 38636843 DOI: 10.1016/j.ijmmb.2024.100594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Candida auris is increasingly being isolated from patients all over the world. It has five clades. In this study, it was aimed to compare the results of biochemical tests obtained using different methods and the antifungal susceptibility profiles of C. auris strains isolated from the first seven cases reported in Türkiye, and evaluate whether this information could be useful as preliminary data in determining the clade of strains in centers that lack the opportunity to apply molecular methods. METHODS Identification test results obtained using API ID 32 C, API 20 C AUX, VITEK-2 YST, and MALDI-TOF MS; colony color and morphology on Chromagar Candida, CHROMagar Candida Plus media, and cornmeal-Tween 80 agar; susceptibility to antifungals were tested and compared. Antifungal susceptibility test was studied using microdilution method according to the recommendations of EUCAST. Additionally, a pilot study was conducted to investigate the value of CHROMagar Candida Plus. RESULTS All seven strains were identified as Lachancea kluyveri with API ID 32 C, Rhodotorula glutinis; Cryptococcus neoformans with API 20 C AUX, and C. auris with both VITEK-2 YST and MALDI-TOF MS. MIC values for fluconazole were very high (≥64 mg/L) for all seven strains. It was observed that 11 (37.9%) of 29 Candida parapsilosis strains formed colonies with morphology similar to C. auris on CHROMagar Candida Plus medium, leading to false positivity. CONCLUSIONS Although there have been many isolations of C. auris in our country in recent years, clade distribution of only a small number of strains is known yet. In this study, when the biochemical properties and antifungal susceptibility profiles of the seven strains were evaluated, it was concluded that they exhibited some characteristics compatible with clade I. It was also observed that strains 1 and 2 may belong to a different clade.
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Affiliation(s)
- Gonca Erkose Genc
- Istanbul University Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkiye.
| | - Ilvana Caklovica Kucukkaya
- Istanbul University Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkiye.
| | - Selda Komec
- Basaksehir Cam and Sakura City Hospital, Laboratory of Medical Microbiology, Istanbul, Turkiye.
| | - Ilke Toker Onder
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkiye.
| | - Oyku Toptas
- Altinbas University Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkiye.
| | - Leyla Teke
- University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Laboratory of Medical Microbiology, Istanbul, Turkiye.
| | - Deniz Turan
- University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Laboratory of Medical Microbiology, Istanbul, Turkiye.
| | - Gokhan Aygun
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkiye.
| | - Dolunay Gulmez
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkiye.
| | - Sevtap Arikan Akdagli
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkiye.
| | - Zayre Erturan
- Istanbul University Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkiye.
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Siopi M, Pachoulis I, Leventaki S, Spruijtenburg B, Meis JF, Pournaras S, Vrioni G, Tsakris A, Meletiadis J. Evaluation of the Vitek 2 system for antifungal susceptibility testing of Candida auris using a representative international panel of clinical isolates: overestimation of amphotericin B resistance and underestimation of fluconazole resistance. J Clin Microbiol 2024; 62:e0152823. [PMID: 38501836 PMCID: PMC11005389 DOI: 10.1128/jcm.01528-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Although the Vitek 2 system is broadly used for antifungal susceptibility testing of Candida spp., its performance against Candida auris has been assessed using limited number of isolates recovered from restricted geographic areas. We therefore compared Vitek 2 system with the reference Clinical and Laboratory Standards Institute (CLSI) broth microdilution method using an international collection of 100 C. auris isolates belonging to different clades. The agreement ±1 twofold dilution between the two methods and the categorical agreement (CA) based on the Centers for Disease Control and Prevention's (CDC's) tentative resistance breakpoints and Vitek 2-specific wild-type upper limit values (WT-ULVs) were determined. The CLSI-Vitek 2 agreement was poor for 5-flucytosine (0%), fluconazole (16%), and amphotericin B (29%), and moderate for voriconazole (61%), micafungin (67%), and caspofungin (81%). Significant interpretation errors were recorded using the CDC breakpoints for amphotericin B (31% CA, 69% major errors; MaEs) and fluconazole (69% CA, 31% very major errors; VmEs), but not for echinocandins (99% CA, 1% MaEs for both micafungin and caspofungin) for which the Vitek 2 allowed correct categorization of echinocandin-resistant FKS1 mutant isolates. Discrepancies were reduced when the Vitek 2 WT-ULV of 16 mg/L for amphotericin B (98% CA, 2% MaEs) and of 4 mg/L for fluconazole (96% CA, 1% MaEs, 3% VmEs) were used. In conclusion, the Vitek 2 system performed well for echinocandin susceptibility testing of C .auris. Resistance to fluconazole was underestimated whereas resistance to amphotericin B was overestimated using the CDC breakpoints of ≥32 and ≥2 mg/L, respectively. Vitek 2 minimun inhibitory concentrations (MICs) >4 mg/L indicated resistance to fluconazole and Vitek 2 MICs ≤16 mg/L indicated non-resistance to amphotericin B.
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Affiliation(s)
- Maria Siopi
- Clinical Microbiology Laboratory, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Molecular Microbiology and Immunology Laboratory, Department of Biomedical Sciences, University of West Attica, Athens, Greece
| | - Ioannis Pachoulis
- Clinical Microbiology Laboratory, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Molecular Microbiology and Immunology Laboratory, Department of Biomedical Sciences, University of West Attica, Athens, Greece
| | - Sevasti Leventaki
- Clinical Microbiology Laboratory, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Molecular Microbiology and Immunology Laboratory, Department of Biomedical Sciences, University of West Attica, Athens, Greece
| | - Bram Spruijtenburg
- Canisius-Wilhelmina Hospital (CWZ)/Dicoon, Nijmegen, the Netherlands
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
| | - Jacques F. Meis
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Spyros Pournaras
- Clinical Microbiology Laboratory, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Vrioni
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Stieber H, Junghanns L, Wilhelm H, Batliner M, Aldejohann AM, Kurzai O, Martin R. The sphingolipid inhibitor myriocin increases Candida auris susceptibility to amphotericin B. Mycoses 2024; 67:e13723. [PMID: 38551121 DOI: 10.1111/myc.13723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The emergence of the pathogenic yeast Candida auris is of global concern due to its ability to cause hospital outbreaks and develop resistance against all antifungal drug classes. Based on published data for baker's yeast Saccharomyces cerevisiae, sphingolipid biosynthesis, which is essential for maintaining membrane fluidity and formation of lipid rafts, could offer a target for additive treatment. METHODS We analysed the susceptibility of C. auris to myriocin, which is an inhibitor of the de novo synthesis of sphingolipids in eukaryotic cells in comparison to other Candida species. In addition, we combined sublethal concentrations of myriocin with the antifungal drugs amphotericin B and fluconazole in E-tests. Consequently, the combinatory effects of myriocin and amphotericin B were examined in broth microdilution assays. RESULTS Myriocin-mediated inhibition of the sphingolipid biosynthesis affected the growth of C. auris. Sublethal myriocin concentrations increased fungal susceptibility to amphotericin B. Isolates which are phenotypically resistant (≥2 mg/L) to amphotericin B became susceptible in presence of myriocin. However, addition of myriocin had only limited effects onto the susceptibility of C. auris against fluconazole. CONCLUSIONS Our results show that inhibition of de novo sphingolipid biosynthesis increases the susceptibility of C. auris to amphotericin B. This may potentially enhance antifungal treatment options fighting this often resistant yeast pathogen.
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Affiliation(s)
- Hanna Stieber
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Lara Junghanns
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Hannah Wilhelm
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Maria Batliner
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Alexander Maximilian Aldejohann
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
- National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute, Jena, Germany
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
- National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute, Jena, Germany
- Research Group Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute, Jena, Germany
| | - Ronny Martin
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
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Hui ST, Gifford H, Rhodes J. Emerging Antifungal Resistance in Fungal Pathogens. CURRENT CLINICAL MICROBIOLOGY REPORTS 2024; 11:43-50. [PMID: 38725545 PMCID: PMC11076205 DOI: 10.1007/s40588-024-00219-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 05/12/2024]
Abstract
Purpose of Review Over recent decades, the number of outbreaks caused by fungi has increased for humans, plants (including important crop species) and animals. Yet this problem is compounded by emerging antifungal drug resistance in pathogenic species. Resistance develops over time when fungi are exposed to drugs either in the patient or in the environment. Recent Findings Novel resistant variants of fungal pathogens that were previously susceptible are evolving (such as Aspergillus fumigatus) as well as newly emerging fungal species that are displaying antifungal resistance profiles (e.g. Candida auris and Trichophyton indotineae). Summary This review highlights the important topic of emerging antifungal resistance in fungal pathogens and how it evolved, as well as how this relates to a growing public health burden.
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Affiliation(s)
- Sui Ting Hui
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Hugh Gifford
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Johanna Rhodes
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- Department of Medical Microbiology, Radboudumc, the Netherlands
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22
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Ettadili H, Vural C. Current global status of Candida auris an emerging multidrug-resistant fungal pathogen: bibliometric analysis and network visualization. Braz J Microbiol 2024; 55:391-402. [PMID: 38261261 PMCID: PMC10920528 DOI: 10.1007/s42770-023-01239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Candida auris is an emerging multidrug-resistant fungal pathogen associated with nosocomial infections and hospital outbreaks worldwide, presenting a serious global health threat. There has been a rapid emergence of scientific research publications focusing on therapeutic compounds, diagnostic techniques, control strategies, prevention, and understanding the epidemiology related to C. auris. OBJECTIVE This study aims to provide the most up-to-date comprehensive and integrated examination of C. auris research subject and demonstrate that C. auris is indeed a topic of increasing interest. METHODS The search query "candida-auris" was used as a topic term to find and retrieve relevant data published between 2009 and 15 June 2023, from the Web of Science Core Collection (WoSCC) database. In this work, the bibliometric analysis and network visualization were conducted using VOSviewer software, and Biblioshiny interface accessible through the Bibliometrix R-package on RStudio software. RESULTS The yearly growth rate percentage (37.91%), along with the strong positive correlations between publications and citations (r = 0.981; p < 0.001), suggests heightened scholarly engagement in this topic. The USA, India, China, and the UK have emerged as pivotal contributors, with the Centers for Disease Control and Prevention (CDC) in the USA being the most productive institution. Current research hotspots in this field mainly focused on identifying and limiting transmission of the clonal strains, epidemiology, antifungal resistance, and in vitro antifungal susceptibility testing. CONCLUSION This detailed bibliometric analysis in C. auris topic shows that this fungal pathogen has garnered growing attention and attracted progressively more scholars. This paper will help researchers to find without difficulty the relevant articles, research hotspots, influential authors, institutions, and countries related to the topic.
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Affiliation(s)
- Hamza Ettadili
- Faculty of Science, Department of Biology, Molecular Biology Section, Pamukkale University, 20160, Denizli, Turkey
| | - Caner Vural
- Faculty of Science, Department of Biology, Molecular Biology Section, Pamukkale University, 20160, Denizli, Turkey.
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23
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Beredaki MI, Sanidopoulos I, Pournaras S, Meletiadis J. Defining Optimal Doses of Liposomal Amphotericin B Against Candida auris: Data From an In Vitro Pharmacokinetic/Pharmacodynamic Model. J Infect Dis 2024; 229:599-607. [PMID: 38109276 PMCID: PMC10873176 DOI: 10.1093/infdis/jiad583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Candida auris isolates exhibit elevated amphotericin B (AMB) minimum inhibitory concentrations (MICs). As liposomal AMB (L-AMB) can be safely administered at high doses, we explored L-AMB pharmacodynamics against C. auris isolates in an in vitro pharmacokinetic/pharmacodynamic (PK/PD) dilution model. METHODS Four C. auris isolates with Clinical and Laboratory Standards Institute (CLSI) AMB MICs = 0.5-2 mg/L were tested in an in vitro PK/PD model simulating L-AMB pharmacokinetics. The in vitro model was validated using a Candida albicans isolate tested in animals. The peak concentration (Cmax)/MIC versus log10 colony-forming units (CFU)/mL reduction from the initial inoculum was analyzed with the sigmoidal model with variable slope (Emax model). Monte Carlo analysis was performed for the standard (3 mg/kg) and higher (5 mg/kg) L-AMB doses. RESULTS The in vitro PK/PD relationship Cmax/MIC versus log10 CFU/mL reduction followed a sigmoidal pattern (R2 = 0.91 for C. albicans, R2 = 0.86 for C. auris). The Cmax/MIC associated with stasis was 2.1 for C. albicans and 9 for C. auris. The probability of target attainment was >95% with 3 mg/kg for wild-type C. albicans isolates with MIC ≤2 mg/L and C. auris isolates with MIC ≤1 mg/L whereas 5 mg/kg L-AMB is needed for C. auris isolates with MIC 2 mg/L. CONCLUSIONS L-AMB was 4-fold less active against C. auris than C. albicans. Candida auris isolates with CLSI MIC 2 mg/L would require a higher L-AMB dose.
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Affiliation(s)
- Maria-Ioanna Beredaki
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Sanidopoulos
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyros Pournaras
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Li J, Aubry L, Brandalise D, Coste AT, Sanglard D, Lamoth F. Upc2-mediated mechanisms of azole resistance in Candida auris. Microbiol Spectr 2024; 12:e0352623. [PMID: 38206035 PMCID: PMC10845950 DOI: 10.1128/spectrum.03526-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Candida auris is an emerging yeast pathogen of major concern because of its ability to cause hospital outbreaks of invasive candidiasis and to develop resistance to antifungal drugs. A majority of C. auris isolates are resistant to fluconazole, an azole drug used for the treatment of invasive candidiasis. Mechanisms of azole resistance are multiple, including mutations in the target gene ERG11 and activation of the transcription factors Tac1b and Mrr1, which control the drug transporters Cdr1 and Mdr1, respectively. We investigated the role of the transcription factor Upc2, which is known to regulate the ergosterol biosynthesis pathway and azole resistance in other Candida spp. Genetic deletion and hyperactivation of Upc2 by epitope tagging in C. auris resulted in drastic increases and decreases in susceptibility to azoles, respectively. This effect was conserved in strains with genetic hyperactivation of Tac1b or Mrr1. Reverse transcription PCR analyses showed that Upc2 regulates ERG11 expression and also activates the Mrr1/Mdr1 pathway. We showed that upregulation of MDR1 by Upc2 could occur independently from Mrr1. The impact of UPC2 deletion on MDR1 expression and azole susceptibility in a hyperactive Mrr1 background was stronger than that of MRR1 deletion in a hyperactive Upc2 background. While Upc2 hyperactivation resulted in a significant increase in the expression of TAC1b, CDR1 expression remained unchanged. Taken together, our results showed that Upc2 is crucial for azole resistance in C. auris, via regulation of the ergosterol biosynthesis pathway and activation of the Mrr1/Mdr1 pathway. Notably, Upc2 is a very potent and direct activator of Mdr1.IMPORTANCECandida auris is a yeast of major medical importance causing nosocomial outbreaks of invasive candidiasis. Its ability to develop resistance to antifungal drugs, in particular to azoles (e.g., fluconazole), is concerning. Understanding the mechanisms of azole resistance in C. auris is important and may help in identifying novel antifungal targets. This study shows the key role of the transcription factor Upc2 in azole resistance of C. auris and shows that this effect is mediated via different pathways, including the regulation of ergosterol biosynthesis and also the direct upregulation of the drug transporter Mdr1.
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Affiliation(s)
- Jizhou Li
- Department of Laboratory Medicine and Pathology, Institute of Microbiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Lola Aubry
- Department of Laboratory Medicine and Pathology, Institute of Microbiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Danielle Brandalise
- Department of Laboratory Medicine and Pathology, Institute of Microbiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Alix T. Coste
- Department of Laboratory Medicine and Pathology, Institute of Microbiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Dominique Sanglard
- Department of Laboratory Medicine and Pathology, Institute of Microbiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Frederic Lamoth
- Department of Laboratory Medicine and Pathology, Institute of Microbiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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25
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Wang Y, Xu J. Associations between Genomic Variants and Antifungal Susceptibilities in the Archived Global Candida auris Population. J Fungi (Basel) 2024; 10:86. [PMID: 38276031 PMCID: PMC10821368 DOI: 10.3390/jof10010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Candida auris is a recently emerged human fungal pathogen that has posed a significant threat to public health. Since its first identification in 2009, this fungus has caused nosocomial infections in over 47 countries across all inhabited continents. As of May 2023, the whole-genome sequences of over 4000 strains have been reported and a diversity of mutations, including in genes known to be associated with drug resistance in other human fungal pathogens, have been described. Among them, 387 strains contained antifungal-susceptibility information for which different methods might be used depending on the drugs and/or investigators. In most reports on C. auris so far, the number of strains analyzed was very small, from one to a few dozen, and the statistical significance of the relationships between these genetic variants and their antifungal susceptibilities could not be assessed. In this study, we conducted genome-wide association studies on individual clades based on previously published C. auris isolates to investigate the statistical association between genomic variants and susceptibility differences to nine antifungal drugs belonging to four major drug categories: 5-fluorocytosine, amphotericin B, fluconazole, voriconazole, itraconazole, posaconazole, anidulafungin, caspofungin, and micafungin. Due to the small sample sizes for Clades II, V, and VI, this study only assessed Clades I, III, and IV. Our analyses revealed 15 single nucleotide polymorphisms (SNPs) in Clade I (10 in coding and 5 in noncoding regions), 24 SNPs in Clade III (11 in coding and 13 in noncoding regions), and 13 SNPs in clade IV (10 in coding and 3 in noncoding regions) as statistically significantly associated with susceptibility differences to one or more of the nine antifungal drugs. While four SNPs in genes encoding lanosterol 14-α-demethylase (ERG11) and the catalytic subunit of 1,3-beta-D-glucan synthase (FKS1) were shared between clades, including the experimentally confirmed Ser639Phe/Pro missense substitutions in FKS1 for echinocandin resistance, most of the identified SNPs were clade specific, consistent with their recent independent origins. Interestingly, the majority of the antifungal resistance-associated SNPs were novel, and in genes and intergenic regions that have never been reported before as associated with antifungal resistance. While targeted study is needed to confirm the role of each novel SNP, the diverse mechanisms of drug resistance in C. auris revealed here indicate both challenges for infection control and opportunities for the development of novel antifungal drugs against this and other human fungal pathogens.
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Affiliation(s)
| | - Jianping Xu
- Department of Biology, McMaster University, Hamilton, ON L8S 4K1, Canada;
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Thomsen J, Abdulrazzaq NM, Oulhaj A, Nyasulu PS, Alatoom A, Denning DW, Al Dhaheri F, Menezes GA, Moubareck CA, Senok A, Everett DB. Emergence of highly resistant Candida auris in the United Arab Emirates: a retrospective analysis of evolving national trends. Front Public Health 2024; 11:1244358. [PMID: 38292390 PMCID: PMC10826512 DOI: 10.3389/fpubh.2023.1244358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/08/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction The Centers for Disease Prevention and Control lists Candida auris, given its global emergence, multidrug resistance, high mortality, and persistent transmissions in health care settings as one of five urgent threats. As a new threat, the need for surveillance of C. auris is critical. This is particularly important for a cosmopolitan setting and global hub such as the United Arab Emirates (UAE) where continued introduction and emergence of resistant variant strains is a major concern. Methods The United Arab Emirates has carried out a 12 years of antimicrobial resistance surveillance (2010-2021) across the country, spanning all seven Emirates. A retrospective analysis of C. auris emergence from 2018-2021 was undertaken, utilising the demographic and microbiological data collected via a unified WHONET platform for AMR surveillance. Results Nine hundred eight non-duplicate C. auris isolates were reported from 2018-2021. An exponential upward trend of cases was found. Most isolates were isolated from urine, blood, skin and soft tissue, and the respiratory tract. UAE nationals nationals comprised 29% (n = 186 of 632) of all patients; the remainder were from 34 other nations. Almost all isolates were from inpatient settings (89.0%, n = 809). The cases show widespread distribution across all reporting sites in the country. C. auris resistance levels remained consistently high across all classes of antifungals used. C. auris in this population remains highly resistant to azoles (fluconazole, 72.6% in 2021) and amphotericin. Echinocandin resistance has now emerged and is increasing annually. There was no statistically significant difference in mortality between Candida auris and Candida spp. (non-auris) patients (p-value: 0.8179), however Candida auris patients had a higher intensive care unit (ICU) admission rate (p-value <0.0001) and longer hospital stay (p < 0.0001) compared to Candida spp. (non-auris) patients. Conclusion The increasing trend of C. auris detection and associated multidrug resistant phenotypes in the UAE is alarming. Continued C. auris circulation in hospitals requires enhanced infection control measures to prevent continued dissemination.
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Affiliation(s)
- Jens Thomsen
- Department of Environmental and Occupational Health and Safey, Abu Dhabi Publich Health Center, Abu Dhabi, United Arab Emirates
- Department of Pathology and Infectious Diseases, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Najiba M. Abdulrazzaq
- Al Kuwait Hospital Dubai, Emirates Health Services Establishment (EHS), Dubai, United Arab Emirates
| | - Abderrahim Oulhaj
- Department of Epidemiology and Public Health, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Peter S. Nyasulu
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adnan Alatoom
- Department of Pathology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - David W. Denning
- Manchester Fungal Infection Group, The University of Manchester, Manchester, United Kingdom
| | - Fatima Al Dhaheri
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Godfred Antony Menezes
- Department of Medical Microbiology and Immunology, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | | | - Abiola Senok
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- School of Dentistry, Cardiff University, Cardiff, United Kingdom
| | - Dean B. Everett
- Department of Pathology and Infectious Diseases, Khalifa University, Abu Dhabi, United Arab Emirates
- Biotechnology Research Center, Khalifa University, Abu Dhabi, United Arab Emirates
- Infection Research Unit, Khalifa University, Abu Dhabi, United Arab Emirates
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Hernando-Ortiz A, Eraso E, Jauregizar N, de Groot PW, Quindós G, Mateo E. Efficacy of the combination of amphotericin B and echinocandins against Candida auris in vitro and in the Caenorhabditis elegans host model. Microbiol Spectr 2024; 12:e0208623. [PMID: 38018978 PMCID: PMC10783041 DOI: 10.1128/spectrum.02086-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/27/2023] [Indexed: 11/30/2023] Open
Abstract
IMPORTANCE Multidrug resistance is a rising problem among non-Candida albicans species, such as Candida auris. This therapeutic problem has been very important during the COVID-19 pandemic. The World Health Organization has included C. auris in its global priority list of health-threatening fungi, to study this emerging multidrug-resistant species and to develop effective alternative therapies. In the present study, the synergistic effect of the combination of amphotericin B and echinocandins has been demonstrated against blood isolates of C. auris. Different susceptibility responses were also observed between aggregative and non-aggregative phenotypes. The antifungal activity of these drug combinations against C. auris was also demonstrated in the Caenorhabditis elegans host model of candidiasis, confirming the suitability and usefulness of this model in the search for solutions to antimicrobial resistance.
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Affiliation(s)
- Ainara Hernando-Ortiz
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Elena Eraso
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Nerea Jauregizar
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Piet W.J. de Groot
- Regional Center for Biomedical Research, University of Castilla-La Mancha, Albacete, Spain
| | - Guillermo Quindós
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Estibaliz Mateo
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Bilbao, Spain
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Wang S, Pan J, Gu L, Wang W, Wei B, Zhang H, Chen J, Wang H. Review of treatment options for a multidrug-resistant fungus: Candida auris. Med Mycol 2024; 62:myad127. [PMID: 38066698 DOI: 10.1093/mmy/myad127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/26/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024] Open
Abstract
Candida auris is a widely distributed, highly lethal, multidrug-resistant fungal pathogen. It was first identified in 2009 when it was isolated from fluid drained from the external ear canal of a patient in Japan. Since then, it has caused infectious outbreaks in over 45 countries, with mortality rates approaching 60%. Drug resistance is common in this species, with a large proportion of isolates displaying fluconazole resistance and nearly half are resistant to two or more antifungal drugs. In this review, we describe the drug resistance mechanism of C. auris and potential small-molecule drugs for treating C. auris infection. Among these antifungal agents, rezafungin was approved by the US Food and Drug Administration (FDA) for the treatment of candidemia and invasive candidiasis on March 22, 2023. Ibrexafungerp and fosmanogepix have entered phase III clinical trials.
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Affiliation(s)
- Siqi Wang
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, and Zhejiang Provincial Key Laboratory of TCM for Innovative R&D and Digital Intelligent Manufacturing of TCM Great Health Products, Zhejiang University of Technology, Hangzhou, China
| | - Jiangwei Pan
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, and Zhejiang Provincial Key Laboratory of TCM for Innovative R&D and Digital Intelligent Manufacturing of TCM Great Health Products, Zhejiang University of Technology, Hangzhou, China
| | - Liting Gu
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, and Zhejiang Provincial Key Laboratory of TCM for Innovative R&D and Digital Intelligent Manufacturing of TCM Great Health Products, Zhejiang University of Technology, Hangzhou, China
| | - Wei Wang
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, and Zhejiang Provincial Key Laboratory of TCM for Innovative R&D and Digital Intelligent Manufacturing of TCM Great Health Products, Zhejiang University of Technology, Hangzhou, China
| | - Bin Wei
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, and Zhejiang Provincial Key Laboratory of TCM for Innovative R&D and Digital Intelligent Manufacturing of TCM Great Health Products, Zhejiang University of Technology, Hangzhou, China
| | - Huawei Zhang
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, and Zhejiang Provincial Key Laboratory of TCM for Innovative R&D and Digital Intelligent Manufacturing of TCM Great Health Products, Zhejiang University of Technology, Hangzhou, China
| | - Jianwei Chen
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, and Zhejiang Provincial Key Laboratory of TCM for Innovative R&D and Digital Intelligent Manufacturing of TCM Great Health Products, Zhejiang University of Technology, Hangzhou, China
| | - Hong Wang
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, and Zhejiang Provincial Key Laboratory of TCM for Innovative R&D and Digital Intelligent Manufacturing of TCM Great Health Products, Zhejiang University of Technology, Hangzhou, China
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Ali B, Kumar M, Kumar P, Chauhan A, Usmani SA, Rudramurthy SM, Meis JF, Chakrabarti A, Singh A, Gaur NA, Mondal AK, Prasad R. Sphingolipid diversity in Candida auris: unraveling interclade and drug resistance fingerprints. FEMS Yeast Res 2024; 24:foae008. [PMID: 38444195 PMCID: PMC10941814 DOI: 10.1093/femsyr/foae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/05/2024] [Accepted: 03/04/2024] [Indexed: 03/07/2024] Open
Abstract
In this study, we explored the sphingolipid (SL) landscape in Candida auris, which plays pivotal roles in fungal biology and drug susceptibility. The composition of SLs exhibited substantial variations at both the SL class and molecular species levels among clade isolates. Utilizing principal component analysis, we successfully differentiated the five clades based on their SL class composition. While phytoceramide (PCer) was uniformly the most abundant SL class in all the isolates, other classes showed significant variations. These variations were not limited to SL class level only as the proportion of different molecular species containing variable number of carbons in fatty acid chains also differed between the isolates. Also a comparative analysis revealed abundance of ceramides and glucosylceramides in fluconazole susceptible isolates. Furthermore, by comparing drug-resistant and susceptible isolates within clade IV, we uncovered significant intraclade differences in key SL classes such as high PCer and low long chain base (LCB) content in resistant strains, underscoring the impact of SL heterogeneity on drug resistance development in C. auris. These findings shed light on the multifaceted interplay between genomic diversity, SLs, and drug resistance in this emerging fungal pathogen.
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Affiliation(s)
- Basharat Ali
- Amity Institute of Integrative Science and Health and Amity Institute of Biotechnology, Amity University Gurgaon, Haryana, 122413, India
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Mohit Kumar
- Amity Institute of Integrative Science and Health and Amity Institute of Biotechnology, Amity University Gurgaon, Haryana, 122413, India
- Yeast Biofuel Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, 110067 India
| | - Praveen Kumar
- Amity Institute of Integrative Science and Health and Amity Institute of Biotechnology, Amity University Gurgaon, Haryana, 122413, India
| | - Anshu Chauhan
- Amity Institute of Integrative Science and Health and Amity Institute of Biotechnology, Amity University Gurgaon, Haryana, 122413, India
| | - Sana Akhtar Usmani
- Department of Biochemistry, University of Lucknow, Lucknow, 226007 India
| | | | - Jacques F Meis
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, 50931 Germany
| | | | - Ashutosh Singh
- Department of Biochemistry, University of Lucknow, Lucknow, 226007 India
| | - Naseem A Gaur
- Yeast Biofuel Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, 110067 India
| | - Alok K Mondal
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Rajendra Prasad
- Amity Institute of Integrative Science and Health and Amity Institute of Biotechnology, Amity University Gurgaon, Haryana, 122413, India
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Lee EH, Choi MH, Lee KH, Kim D, Jeong SH, Song YG, Han SH. Intrahospital transmission and infection control of Candida auris originating from a severely infected COVID-19 patient transferred abroad. J Hosp Infect 2024; 143:140-149. [PMID: 37939883 DOI: 10.1016/j.jhin.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Intrahospital spread of Candida auris, which survives tenaciously in many environments, can cause sustained colonization and infection. A large outbreak of C. auris was experienced in the intensive care units (ICUs) at the study hospital during the coronavirus disease 2019 (COVID-19) pandemic. METHODS The index patient with severe COVID-19, who was transferred from Vietnam in January 2022, developed C. auris candidaemia 10 days after hospitalization. From mid-June 2022 to January 2023, strengthened infection prevention and control (IPC) measures were implemented in three ICUs: (1) contact precautions and isolation (CPI) for C. auris-positive cases; (2) surveillance cultures including point-prevalence (N=718) for patients or close contacts or ICU-resident healthcare workers (HCWs); (3) intensive environmental disinfection with 10-fold diluted bleach; and (4) 2% chlorhexidine bathing for all ICU patients. Environmental cultures (ECx) on surfaces and shared objects (N=276) were conducted until early September 2022, when all ECx were negative. RESULTS Among 53 C. auris-positive patients between February 2022 and January 2023, invasive infections resulted in seven cases of candidaemia and one case of pneumonia. C. auris was isolated from reusable tympanic thermometers (TTMs) contaminated with earwax. The isolation rate of C. auris in ECx decreased from 6.8% in June 2022 to 2.0% in August 2022, and was no longer detected in TTMs. Colonization in HCWs was remarkably rare (0.5%). The number of C. auris-positive patients peaked in July (N=10) then decreased gradually. By January 2023, no C. auris were isolated in the ICU. CONCLUSION Aggressive IPC measures with CPI, ECx and surveillance, decontamination of TTMs, and bathing were effective in successfully controlling this C. auris outbreak.
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Affiliation(s)
- E H Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - M H Choi
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - K H Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S H Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y G Song
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S H Han
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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31
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Nysten J, Sofras D, Van Dijck P. One species, many faces: The underappreciated importance of strain diversity. PLoS Pathog 2024; 20:e1011931. [PMID: 38271302 PMCID: PMC10810500 DOI: 10.1371/journal.ppat.1011931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Affiliation(s)
- Jana Nysten
- Laboratory of Molecular Cell Biology, Department of Biology, Institute of Botany and Microbiology, KU Leuven, Leuven, Belgium
| | - Dimitrios Sofras
- Laboratory of Molecular Cell Biology, Department of Biology, Institute of Botany and Microbiology, KU Leuven, Leuven, Belgium
| | - Patrick Van Dijck
- Laboratory of Molecular Cell Biology, Department of Biology, Institute of Botany and Microbiology, KU Leuven, Leuven, Belgium
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Govrins M, Lass-Flörl C. Candida parapsilosis complex in the clinical setting. Nat Rev Microbiol 2024; 22:46-59. [PMID: 37674021 DOI: 10.1038/s41579-023-00961-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/08/2023]
Abstract
Representatives of the Candida parapsilosis complex are important yeast species causing human infections, including candidaemia as one of the leading diseases. This complex comprises C. parapsilosis, Candida orthopsilosis and Candida metapsilosis, and causes a wide range of clinical presentations from colonization to superficial and disseminated infections with a high prevalence in preterm-born infants and the potential to cause outbreaks in hospital settings. Compared with other Candida species, the C. parapsilosis complex shows high minimal inhibitory concentrations for echinocandin drugs due to a naturally occurring FKS1 polymorphism. The emergence of clonal outbreaks of strains with resistance to commonly used antifungals, such as fluconazole, is causing concern. In this Review, we present the latest medical data covering epidemiology, diagnosis, resistance and current treatment approaches for the C. parapsilosis complex. We describe its main clinical manifestations in adults and children and highlight new treatment options. We compare the three sister species, examining key elements of microbiology and clinical characteristics, including the population at risk, disease manifestation and colonization status. Finally, we provide a comprehensive resource for clinicians and researchers focusing on Candida species infections and the C. parapsilosis complex, aiming to bridge the emerging translational knowledge and future therapeutic challenges associated with this human pathogen.
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Affiliation(s)
- Miriam Govrins
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.
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Chow EWL, Song Y, Chen J, Xu X, Wang J, Chen K, Gao J, Wang Y. The transcription factor Rpn4 activates its own transcription and induces efflux pump expression to confer fluconazole resistance in Candida auris. mBio 2023; 14:e0268823. [PMID: 38014938 PMCID: PMC10746192 DOI: 10.1128/mbio.02688-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023] Open
Abstract
IMPORTANCE Candida auris is a recently emerged pathogenic fungus of grave concern globally due to its resistance to conventional antifungals. This study takes a whole-genome approach to explore how C. auris overcomes growth inhibition imposed by the common antifungal drug fluconazole. We focused on gene disruptions caused by a "jumping genetic element" called transposon, leading to fluconazole resistance. We identified mutations in two genes, each encoding a component of the Ubr2/Mub1 ubiquitin-ligase complex, which marks the transcription regulator Rpn4 for degradation. When either protein is absent, stable Rpn4 accumulates in the cell. We found that Rpn4 activates the expression of itself as well as the main drug efflux pump gene CDR1 by binding to a PACE element in the promoter. Furthermore, we identified an amino acid change in Ubr2 in many resistant clinical isolates, contributing to Rpn4 stabilization and increased fluconazole resistance.
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Affiliation(s)
- Eve W. L. Chow
- Infectious Diseases Labs, Agency for Science, Technology and Research, Singapore, Singapore
| | - Yabing Song
- School of Life Sciences, Tsinghua University, Beijing, China
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Jinxin Chen
- School of Life Sciences, Tsinghua University, Beijing, China
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Xiaoli Xu
- Infectious Diseases Labs, Agency for Science, Technology and Research, Singapore, Singapore
| | - Jianbin Wang
- School of Life Sciences, Tsinghua University, Beijing, China
- Beijing Frontier Research Center for Biological Structure, Tsinghua University, Beijing, China
| | - Kun Chen
- Translational Medical Center for Stem Cell Therapy, Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Signaling and Disease Research, Frontier Science Center for Stem Cell Research, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Jiaxin Gao
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Yue Wang
- Infectious Diseases Labs, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Zheng L, Xu Y, Wang C, Yang F, Dong Y, Guo L. Susceptibility to caspofungin is regulated by temperature and is dependent on calcineurin in Candida albicans. Microbiol Spectr 2023; 11:e0179023. [PMID: 37966204 PMCID: PMC10715083 DOI: 10.1128/spectrum.01790-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/06/2023] [Indexed: 11/16/2023] Open
Abstract
IMPORTANCE Echinocandins are the newest antifungal drugs and are first-line treatment option for life-threatening systemic infections. Due to lack of consensus regarding what temperature should be used when evaluating susceptibility of yeasts to echinocandins, typically either 30°C, 35°C, or 37°C is used. However, the impact of temperature on antifungal efficacy of echinocandins is unexplored. In the current study, we demonstrated that Candida albicans laboratory strain SC5314 was more susceptible to caspofungin at 37°C than at 30°C. We also found that calcineurin was required for temperature-modulated caspofungin susceptibility. Surprisingly, the altered caspofungin susceptibility was not due to differential expression of some canonical genes such as FKS, CHS, or CHT genes. The molecular mechanism of temperature-modulated caspofungin susceptibility is undetermined and deserves further investigations.
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Affiliation(s)
- Lijun Zheng
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Xu
- Department of Pharmacy, The 960 Hospital of PLA, Jinan, China
| | - Chen Wang
- Department of Pharmacy, The 960 Hospital of PLA, Jinan, China
| | - Feng Yang
- Department of Pharmacology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yubo Dong
- Department of Pharmacy, The 960 Hospital of PLA, Jinan, China
| | - Liangsheng Guo
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Wang Q, Cheng S, Wang Y, Li F, Chen J, Du W, Kang H, Wang Z. Global characteristics and trends in research on Candida auris. Front Microbiol 2023; 14:1287003. [PMID: 38125576 PMCID: PMC10731253 DOI: 10.3389/fmicb.2023.1287003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Candida auris, a fungal pathogen first reported in 2009, has shown strong resistance to azole antifungal drugs and has caused severe nosocomial outbreaks. It can also form biofilms, which can colonize patients' skin and transmit to others. Despite numerous reports of C. auris isolation in various countries, many studies have reported contradictory results. Method A bibliometric analysis was conducted using VOSviewer to summarize research trends and provide guidance for future research on controlling C. auris infection. The analysis revealed that the United States and the US CDC were the most influential countries and research institutions, respectively. For the researchers, Jacques F. Meis published the highest amount of related articles, and Anastasia P. Litvintseva's articles with the highest average citation rate. The most cited publications focused on clade classification, accurate identification technologies, nosocomial outbreaks, drug resistance, and biofilm formation. Keyword co-occurrence analysis revealed that the top five highest frequencies were for 'drug resistance,' 'antifungal susceptibility test,' 'infection,' 'Candida auris,' and 'identification.' The high-frequency keywords clustered into four groups: rapid and precise identification, drug resistance research, pathogenicity, and nosocomial transmission epidemiology studies. These clusters represent different study fields and current research hotspots of C. auris. Conclusion The bibliometric analysis identified the most influential country, research institution, and researcher, indicating current research trends and hotspots for controlling C. auris.
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Affiliation(s)
- Qihui Wang
- Laboratory of Microbiology, Department of Clinical Laboratory, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shitong Cheng
- Laboratory of Microbiology, Department of Clinical Laboratory, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yinling Wang
- Laboratory of Microbiology, Department of Clinical Laboratory, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Fushun Li
- Laboratory of Microbiology, Department of Clinical Laboratory, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jingjing Chen
- Laboratory of Microbiology, Department of Clinical Laboratory, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wei Du
- National Clinical Research Center for Laboratory Medicine, Department of Clinical Laboratory, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hui Kang
- Laboratory of Microbiology, Department of Clinical Laboratory, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhongqing Wang
- Department of Information Centre, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Halliday C, Kim HY, Tay E, Chen SCA, Alffenaar JW. Exploring synergy between azole antifungal drugs and statins for Candida auris. J Antimicrob Chemother 2023; 78:2824-2829. [PMID: 37823357 PMCID: PMC10689908 DOI: 10.1093/jac/dkad303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Global emergence of rapidly developing resistance to multiple antifungal drugs and high mortality pose challenges to the treatment of invasive Candida auris infections. New therapeutic approaches are needed, such as repurposing drugs including combination with antifungals. Statins have been reported to exert antifungal effects against various Candida species. OBJECTIVES Our study investigated potential synergy between the statins (rosuvastatin and fluvastatin) and azoles (voriconazole, posaconazole and isavuconazole) on clinical isolates of C. auris. METHODS Twenty-one clinical isolates of C. auris were obtained. Chequerboard assays based on the CLSI broth microdilution method were used to assess synergy based on FIC index (FICI) calculations of MICs of individual drugs and in combinations. RESULTS Single drug geometric mean (GM) MICs of fluvastatin and rosuvastatin were ≥128 mg/L in all 21 isolates. GM (range) MICs of posaconazole, voriconazole and isavuconazole were 0.259 (0.016-1 mg/L), 0.469 (0.016-2 mg/L) and 0.085 (0.004-1 mg/L), respectively. Combination of azoles with fluvastatin showed synergy in 70%-90% of C. auris isolates. In particular, voriconazole/fluvastatin resulted in 16-fold reduction in voriconazole MIC and synergy in 14/21 (67%) isolates. Posaconazole/fluvastatin resulted in 8-fold reduction in posaconazole MIC and synergy in 19/21 (90%) isolates.Combining rosuvastatin with the azoles also showed synergy against C. auris in 40%-60% of the isolates and additive effect in 40%-50%. None of the combinations was antagonistic. CONCLUSIONS Our results provide a rationale for pursuing in vivo synergy tests as well as clinical studies to explore tolerability, treatment outcomes, optimal dose and exposure targets.
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Affiliation(s)
- Catriona Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Hannah Yejin Kim
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, A15 Science Rd, Camperdown, NSW 2006, Australia
- Department of Pharmacy, Westmead Hospital, Westmead, NSW, Australia
- The University of Sydney Infectious Diseases Institute (Sydney ID), Westmead, NSW, Australia
| | - Enoch Tay
- Research Education Network, Western Sydney Local Health District, Westmead Hospital, Westmead, NSW, Australia
| | - Sharon C A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Westmead, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Jan-Willem Alffenaar
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, A15 Science Rd, Camperdown, NSW 2006, Australia
- The University of Sydney Infectious Diseases Institute (Sydney ID), Westmead, NSW, Australia
- Westmead Hospital, Westmead, NSW, Australia
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Erturk Sengel B, Ekren BY, Sayin E, Cerikcioglu N, Sezerman U, Odabasi Z. Identification of Molecular and Genetic Resistance Mechanisms in a Candida auris Isolate in a Tertiary Care Center in Türkiye. Mycopathologia 2023; 188:929-936. [PMID: 37639054 DOI: 10.1007/s11046-023-00787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Candida auris is a multidrug-resistant pathogen that causes nosocomial outbreaks and high mortality. We conducted this study to investigate the molecular mechanisms of antifungal resistance in our clinical isolate of C. auris with a high level of resistance to three main classes of antifungals. MATERIAL AND METHODS A clinical C. auris isolate was identified by MALDI-TOF MS and antifungal susceptibilities were determined by the Sensititre YeastOne YO10 panel. After sequencing the whole genome of the microorganism with Oxford Nanopore NGS Technologies, a phylogenetic tree was drawn as a cladogram to detect where the C. auris clade to this study's assembly belongs. RESULTS The C. auris isolate in this study (MaCa01) was determined to be a part of the clade I (South Asian). The resistance-related genes indicated that MaCa01 would most likely be highly resistant to fluconazole (CDR1, TAC1b, and ERG11), none or little resistant to amphotericin B (AmpB) and echinocandins, and sensitive to flucytosine. The mutations found in the above-mentioned genes in the Türkiye C. auris isolate reveals an antifungal resistance pattern. This molecular resistance pattern was found consistent with the interpretation of MIC values of the antifungals according to CDC tentative breakpoints. CONCLUSION We detected the well-known antifungal resistance mutations, responsible for azole resistance in C. auris. Despite no ERG2, ERG6, and FKS mutation identified, the isolate was found to be resistant to AmpB and caspofungin based on the CDC tentative breakpoints which could be related to unidentified mutations.
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Affiliation(s)
- Buket Erturk Sengel
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Türkiye.
| | - Berkay Yekta Ekren
- Department of Bioistatistics and Medical Informatics, Graduate School of Health Sciences, Acibadem University, Istanbul, Türkiye
| | - Elvan Sayin
- Department of Medical Microbiology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Nilgun Cerikcioglu
- Department of Medical Microbiology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Ugur Sezerman
- Department of Bioistatistics and Medical Informatics, Graduate School of Health Sciences, Acibadem University, Istanbul, Türkiye
| | - Zekaver Odabasi
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Türkiye
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Eisenstein M. How high-impact papers from Indian researchers are shaping science. Nature 2023; 624:S34-S36. [PMID: 38092933 DOI: 10.1038/d41586-023-03913-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
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Lockhart SR, Chowdhary A, Gold JAW. The rapid emergence of antifungal-resistant human-pathogenic fungi. Nat Rev Microbiol 2023; 21:818-832. [PMID: 37648790 DOI: 10.1038/s41579-023-00960-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/01/2023]
Abstract
During recent decades, the emergence of pathogenic fungi has posed an increasing public health threat, particularly given the limited number of antifungal drugs available to treat invasive infections. In this Review, we discuss the global emergence and spread of three emerging antifungal-resistant fungi: Candida auris, driven by global health-care transmission and possibly facilitated by climate change; azole-resistant Aspergillus fumigatus, driven by the selection facilitated by azole fungicide use in agricultural and other settings; and Trichophyton indotineae, driven by the under-regulated use of over-the-counter high-potency corticosteroid-containing antifungal creams. The diversity of the fungi themselves and the drivers of their emergence make it clear that we cannot predict what might emerge next. Therefore, vigilance is critical to monitoring fungal emergence, as well as the rise in overall antifungal resistance.
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Affiliation(s)
- Shawn R Lockhart
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Medical Mycology Unit, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Jeremy A W Gold
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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40
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Horton MV, Holt AM, Nett JE. Mechanisms of pathogenicity for the emerging fungus Candida auris. PLoS Pathog 2023; 19:e1011843. [PMID: 38127686 PMCID: PMC10735027 DOI: 10.1371/journal.ppat.1011843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Candida auris recently emerged as an urgent public health threat, causing outbreaks of invasive infections in healthcare settings throughout the world. This fungal pathogen persists on the skin of patients and on abiotic surfaces despite antiseptic and decolonization attempts. The heightened capacity for skin colonization and environmental persistence promotes rapid nosocomial spread. Following skin colonization, C. auris can gain entrance to the bloodstream and deeper tissues, often through a wound or an inserted medical device, such as a catheter. C. auris possesses a variety of virulence traits, including the capacity for biofilm formation, production of adhesins and proteases, and evasion of innate immune responses. In this review, we highlight the interactions of C. auris with the host, emphasizing the intersection of laboratory studies and clinical observations.
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Affiliation(s)
- Mark V. Horton
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
- Department of Medical Microbiology & Immunology, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Ashley M. Holt
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
- Department of Medical Microbiology & Immunology, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Jeniel E. Nett
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
- Department of Medical Microbiology & Immunology, University of Wisconsin, Madison, Wisconsin, United States of America
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41
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Spruijtenburg B, Ahmad S, Asadzadeh M, Alfouzan W, Al-Obaid I, Mokaddas E, Meijer EFJ, Meis JF, de Groot T. Whole genome sequencing analysis demonstrates therapy-induced echinocandin resistance in Candida auris isolates. Mycoses 2023; 66:1079-1086. [PMID: 37712885 DOI: 10.1111/myc.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/02/2023] [Indexed: 09/16/2023]
Abstract
Candida auris is an emerging, multidrug-resistant yeast, causing outbreaks in healthcare facilities. Echinocandins are the antifungal drugs of choice to treat candidiasis, as they cause few side effects and resistance is rarely found. Previously, immunocompromised patients from Kuwait with C. auris colonisation or infection were treated with echinocandins, and within days to months, resistance was reported in urine isolates. To determine whether the development of echinocandin resistance was due to independent introductions of resistant strains or resulted from intra-patient resistance development, whole genome sequencing (WGS) single-nucleotide polymorphism (SNP) analysis was performed on susceptible (n = 26) and echinocandin-resistant (n = 6) isolates from seven patients. WGS SNP analysis identified three distinct clusters differing 17-127 SNPs from two patients, and the remaining isolates from five patients, respectively. Sequential isolates within patients had a maximum of 11 SNP differences over a time period of 1-10 months. The majority of isolates with reduced susceptibility displayed unique FKS1 substitutions including a novel FKS1M690V substitution, and nearly all were genetically related, ranging from only three to six SNP differences compared to susceptible isolates from the same patient. Resistant isolates from three patients shared the common FKS1S639F substitution; however, WGS analysis did not suggest a common source. These findings strongly indicate that echinocandin resistance is induced during antifungal treatment. Future studies should determine whether such echinocandin-resistant strains are capable of long-term colonisation, cause subsequent breakthrough candidiasis, have a propensity to cross-infect other patients, or remain viable for longer time periods in the hospital environment.
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Affiliation(s)
- Bram Spruijtenburg
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Center of Expertise for Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Mohammad Asadzadeh
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Wadha Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Microbiology Unit, Department of Laboratory Medicine, Farwania Hospital, Kuwait City, Kuwait
| | - Inaam Al-Obaid
- Department of Microbiology, Al-Sabah Hospital, Shuwaikh, Kuwait
| | - Eiman Mokaddas
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Department of Microbiology, Ibn-Sina Hospital, Shuwaikh, Kuwait
| | - Eelco F J Meijer
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Center of Expertise for Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jacques F Meis
- Center of Expertise for Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Theun de Groot
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Center of Expertise for Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Miramón P, Pountain AW, Lorenz MC. Candida auris-macrophage cellular interactions and transcriptional response. Infect Immun 2023; 91:e0027423. [PMID: 37815367 PMCID: PMC10652981 DOI: 10.1128/iai.00274-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/29/2023] [Indexed: 10/11/2023] Open
Abstract
The pathogenic yeast Candida auris represents a global threat of the utmost clinical relevance. This emerging fungal species is remarkable in its resistance to commonly used antifungal agents and its persistence in the nosocomial settings. The innate immune system is one the first lines of defense preventing the dissemination of pathogens in the host. C. auris is susceptible to circulating phagocytes, and understanding the molecular details of these interactions may suggest routes to improved therapies. In this work, we examined the interactions of this yeast with macrophages. We found that macrophages avidly phagocytose C. auris; however, intracellular replication is not inhibited, indicating that C. auris resists the killing mechanisms imposed by the phagocyte. Unlike Candida albicans, phagocytosis of C. auris does not induce macrophage lysis. The transcriptional response of C. auris to macrophage phagocytosis is very similar to other members of the CUG clade (C. albicans, C. tropicalis, C. parapsilosis, C. lusitaniae), i.e., downregulation of transcription/translation and upregulation of alternative carbon metabolism pathways, transporters, and induction of oxidative stress response and proteolysis. Gene family expansions are common in this yeast, and we found that many of these genes are induced in response to macrophage co-incubation. Among these, amino acid and oligopeptide transporters, as well as lipases and proteases, are upregulated. Thus, C. auris shares key transcriptional signatures shared with other fungal pathogens and capitalizes on the expansion of gene families coding for potential virulence attributes that allow its survival, persistence, and evasion of the innate immune system.
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Affiliation(s)
- Pedro Miramón
- Department of Microbiology and Molecular Genetics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, USA
| | | | - Michael C. Lorenz
- Department of Microbiology and Molecular Genetics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, USA
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43
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Ahmadi B, Naeimi B, Ahmadipour MJ, Morovati H, de Groot T, Spruijtenburg B, Badali H, Meis JF. An Autochthonous Susceptible Candida auris Clade I Otomycosis Case in Iran. J Fungi (Basel) 2023; 9:1101. [PMID: 37998906 PMCID: PMC10671974 DOI: 10.3390/jof9111101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
Candida auris is a newly emerging multidrug-resistant fungal pathogen considered to be a serious global health threat. Due to diagnostic challenges, there is no precise estimate for the prevalence rate of this pathogen in Iran. Since 2019, only six culture-proven C. auris cases have been reported from Iran, of which, five belonged to clade V and one to clade I. Herein, we report a case of otomycosis due to C. auris from 2017 in a 78-year-old man with diabetes mellitus type II without an epidemiological link to other cases or travel history. Short tandem repeat genotyping and whole genome sequencing (WGS) analysis revealed that this isolate belonged to clade I of C. auris (South Asian Clade). The WGS single nucleotide polymorphism calling demonstrated that the C. auris isolate from 2017 is not related to a previously reported clade I isolate from Iran. The presence of this retrospectively recognized clade I isolate also suggests an early introduction from other regions or an autochthonous presence. Although the majority of reported C. auris isolates worldwide are resistant to fluconazole and, to a lesser extent, to echinocandins and amphotericin B, the reported clade I isolate from Iran was susceptible to all antifungal drugs.
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Affiliation(s)
- Bahram Ahmadi
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr 75187-59577, Iran; (B.A.); (B.N.)
| | - Behrouz Naeimi
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr 75187-59577, Iran; (B.A.); (B.N.)
| | | | - Hamid Morovati
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran;
| | - Theun de Groot
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands; (T.d.G.); (B.S.)
- Center of Expertise for Mycology, Radboud University Medical Center/Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Bram Spruijtenburg
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands; (T.d.G.); (B.S.)
- Center of Expertise for Mycology, Radboud University Medical Center/Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Hamid Badali
- Department of Molecular Microbiology & Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas, San Antonio, TX 78249, USA
| | - Jacques F. Meis
- Center of Expertise for Mycology, Radboud University Medical Center/Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Excellence Center for Medical Mycology (ECMM), University of Cologne, 50923 Cologne, Germany
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Stover KR, Hawkins BK, Keck JM, Barber KE, Cretella DA. Antifungal resistance, combinations and pipeline: oh my! Drugs Context 2023; 12:2023-7-1. [PMID: 38021410 PMCID: PMC10653594 DOI: 10.7573/dic.2023-7-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023] Open
Abstract
Invasive fungal infections are a strong contributor to healthcare costs, morbidity and mortality, especially amongst hospitalized patients. Historically, Candida was responsible for approximately 15% of all nosocomial bloodstream infections. In the past 10 years, the epidemiology of Candida species has altered, with increasing prevalence of resistant species. With rising fungal resistance, especially in Candida spp., the demand for novel antifungal therapies has exponentially increased over the last decade. Newer antifungal agents have become an attractive option for patients needing long-term therapy for infections or those requiring antifungal prophylaxis. Despite advances in coverage of non-Candida pathogens with newer agents, clinical scenarios involving multidrug-resistant fungal pathogens continue to arise in practice. Combination antifungal therapy can lead to a host of side-effects, some of which can be drug limiting. Additional antifungal therapies with enhanced fungal spectrum of activity and decreased rates of adverse effects are warranted. Fosmanogepix, ibrexafungerp, olorofim and rezafungin may help fill some of these gaps in the antifungal armamentarium. This article is part of the Challenges and strategies in the management of invasive fungal infections Special Issue: https://www.drugsincontext.com/special_issues/challenges-and-strategies-in-the-management-of-invasive-fungal-infections.
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Affiliation(s)
- Kayla R Stover
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA
| | - Brandon K Hawkins
- Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center, Knoxville, TN, USA
| | - J Myles Keck
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Katie E Barber
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA
| | - David A Cretella
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
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Kurakado S, Matsumoto Y, Sugita T. Comparing the virulence of four major clades of Candida auris strains using a silkworm infection model: Clade IV isolates had higher virulence than the other clades. Med Mycol 2023; 61:myad108. [PMID: 37898558 DOI: 10.1093/mmy/myad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/21/2023] [Accepted: 10/27/2023] [Indexed: 10/30/2023] Open
Abstract
Candida auris is an emerging fungal pathogen that is feared to spread of infection because of its propensity for multidrug resistance and high mortality rate. This pathogenic yeast is classified into four major clades by phylogenetic analyses, which are referred to the South Asia clade (clade I), East Asia clade (clade II), South Africa clade (clade III), and South America clade (clade IV), based on the location of the initial isolate. In this study, we evaluated the virulence of C. auris strains belonging to four major clades and the therapeutic effects of micafungin in a silkworm infection model. The highest mortality rate at 21 h after C. auris inoculation was observed for strains from clade IV (80% or more). In contrast, it was 20% or less in those from other clades. Antifungal susceptibility tests indicated resistance to fluconazole and sensitivity to echinocandins in the blood-derived strains. Micafungin prolonged the survival of blood-derived C. auris infected silkworms. These results suggest that the silkworm infection model is useful for evaluating the virulence of C. auris and determining its therapeutic effects.
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Affiliation(s)
- Sanae Kurakado
- Department of Microbiology, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Yasuhiko Matsumoto
- Department of Microbiology, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Takashi Sugita
- Department of Microbiology, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose, Tokyo 204-8588, Japan
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Singh P, Srivastava S, Malhotra R, Mathur P. Identification of Candida auris by PCR and assessment of biofilm formation by crystal violet assay. Indian J Med Microbiol 2023; 46:100421. [PMID: 37945115 DOI: 10.1016/j.ijmmb.2023.100421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Candida auris is a notorious pathogen capable of forming biofilms on devices as well as host tissues, often culminating in infections. We evaluated characteristics of infections and the methods to diagnose C. auris over a period of three years in a tertiary care hospital. METHODS Patients admitted between 2018 and 2020, who had candidemia due to C. auris were included in the study. Identification was performed using HiCrome™ Candida Differential Agar, Vitek 2 (BioMérieux, Inc., Marcy-l'Etoile, France) and MALDI-TOF, Vitek-MS. Identification was confirmed by detection of rDNA region covering part of 5.8S, entire of ITS2, and part of 28S by polymerase chain reaction (PCR). Biofilm formation was assessed by crystal violet staining. RESULTS Presence of central line and broad spectrum antimicrobials were noted in all patients whereas total parenteral nutrition was given in 82.1% of these patients. Identification by Vitek2 v8.1 correlated with MALDI-TOF MS. PCR products of length 163 bp were obtained in all isolates as visualized by agarose gel electrophoresis. The biofilm quantity measured as A560 of the twenty-eight C. auris isolates ranged from 0.16 to 0.80 compared to C. albicans. CONCLUSIONS C. auris can be identified by PCR targeting specific rDNA region. Biofilm formation and quantification can be achieved by growing C. auris isolates in Mueller-Hinton broth over a duration of 48 h.
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Affiliation(s)
- Parul Singh
- Department of Microbiology, Trauma Centre, AIIMS, New Delhi, India.
| | | | - Rajesh Malhotra
- Department of Orthopaedics & Chief, Trauma Centre, AIIMS, New Delhi, India.
| | - Purva Mathur
- Department of Laboratory Medicine, Trauma Centre, AIIMS, New Delhi, India.
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Oyardi O, Demir ES, Alkan B, Komec S, Genc GE, Aygun G, Teke L, Turan D, Erturan Z, Savage PB, Guzel CB. Phenotypic Investigation of Virulence Factors, Susceptibility to Ceragenins, and the Impact of Biofilm Formation on Drug Efficacy in Candida auris Isolates from Türkiye. J Fungi (Basel) 2023; 9:1026. [PMID: 37888282 PMCID: PMC10607835 DOI: 10.3390/jof9101026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
Candida auris has emerged as a significant fungal threat due to its rapid worldwide spread since its first appearance, along with its potential for antimicrobial resistance and virulence properties. This study was designed to examine virulence characteristics, the efficacy of ceragenins, and biofilm-derived drug resistance in seven C. auris strains isolated from Turkish intensive care patients. It was observed that none of the tested strains exhibited proteinase or hemolysis activity; however, they demonstrated weak phospholipase and esterase activity. In addition, all strains were identified as having moderate to strong biofilm formation characteristics. Upon determining the minimum inhibitory concentrations (MIC) of ceragenins, it was discovered that CSA-138 exhibited the highest effectiveness with a MIC range of 1-0.5 µg/mL, followed by CSA-131 with a MIC of 1 µg/mL. Also, antimicrobial agents destroyed mature biofilms at high concentrations (40-1280 µg/mL). The investigation revealed that the strains isolated from Türkiye displayed weak exoenzyme activities. Notably, the ceragenins exhibited effectiveness against these strains, suggesting their potential as a viable treatment option.
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Affiliation(s)
- Ozlem Oyardi
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Gazi University, Ankara 06330, Türkiye
| | - Elif Sena Demir
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Istanbul 34116, Türkiye; (E.S.D.); (B.A.); (C.B.G.)
| | - Busra Alkan
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Istanbul 34116, Türkiye; (E.S.D.); (B.A.); (C.B.G.)
| | - Selda Komec
- Laboratory of Medical Microbiology, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Türkiye;
| | - Gonca Erkose Genc
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Türkiye; (G.E.G.); (Z.E.)
| | - Gokhan Aygun
- Department of Medical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Türkiye;
| | - Leyla Teke
- Clinic of Microbiology, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul 34255, Türkiye;
| | - Deniz Turan
- Medical Microbiology Laboratory, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul 34668, Türkiye;
| | - Zayre Erturan
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Türkiye; (G.E.G.); (Z.E.)
| | - Paul B. Savage
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT 84602, USA;
| | - Cagla Bozkurt Guzel
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Istanbul 34116, Türkiye; (E.S.D.); (B.A.); (C.B.G.)
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Villanueva-Lozano H, Trejo-Castro AI, Carrion-Alvarez D, Lozano-Díaz ST, Martinez-Torteya A. A Bibliometric Review on Candida auris of the First Fifteen Years of Research (2009-2023). BIOMED RESEARCH INTERNATIONAL 2023; 2023:2385018. [PMID: 37869631 PMCID: PMC10586903 DOI: 10.1155/2023/2385018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/20/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
Introduction Candida auris is a relatively novel pathogen first described in 2009 in Japan. It has increased its presence worldwide, becoming a public health concern due to its innate resistance to antifungals and outbreak potential. Methods We performed a query using the word "Candida auris" from the Scopus database, further performing a bibliometric analysis with the open-source R package Bibliometrix. Results 907 original articles were retrieved, allowing us to map the principal authors, papers, journals, and countries involved in this yeast research, as well as analyze current and future trends and the number of published articles. Conclusion C. auris will continue to be a pivotal point in fungal resistance research, either for a better understanding of its resistance and pathogenic mechanisms or for developing novel drugs.
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Affiliation(s)
- Hiram Villanueva-Lozano
- Internal Medicine Department, ISSSTE Regional Monterrey, Monterrey 64380, Nuevo Leon, Mexico
| | - Alejandro I. Trejo-Castro
- School of Medicine and Health Sciences, Tecnológico de Monterrey, Monterrey 64710, Nuevo Leon, Mexico
- Bicultural Nursing Program, Instituto Humanístico de la Salud, Nuevo Laredo 88000, Tamaulipas, Mexico
| | - Diego Carrion-Alvarez
- Internal Medicine Department, ISSSTE Regional Monterrey, Monterrey 64380, Nuevo Leon, Mexico
- Health Sciences, Universidad de Monterrey, San Pedro Garza García 66238, Nuevo Leon, Mexico
| | - Sofía T. Lozano-Díaz
- Health Sciences, Universidad de Monterrey, San Pedro Garza García 66238, Nuevo Leon, Mexico
| | - Antonio Martinez-Torteya
- School of Engineering and Technology, Universidad de Monterrey, San Pedro Garza García 66238, Nuevo Leon, Mexico
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Mulet Bayona JV, Tormo Palop N, Salvador García C, Guna Serrano MDR, Gimeno Cardona C. Candida auris from colonisation to candidemia: A four-year study. Mycoses 2023; 66:882-890. [PMID: 37401661 DOI: 10.1111/myc.13626] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Candida auris has become a worrisome multi-drug resistant healthcare-associated pathogen due to its capacity to colonise patients and surfaces and to cause outbreaks of invasive infections in critically ill patients. OBJECTIVES This study evaluated the outbreak in our setting in a 4-year period, reporting the risk factors for developing candidemia in previously colonised patients, the therapeutic measures for candidemia and the outcome of candidemia and colonisation cases among all C. auris isolates and their susceptibility to antifungals. METHODS Data were retrospectively collected from patients admitted to Consorcio Hospital General Universitario de Valencia (Spain) from September 2017 to September 2021. A retrospective case-control study was designed to identify risk factors for developing C. auris candidemia in previously colonised patients. RESULTS C. auris affected 550 patients, of which 210 (38.2%) had some clinical sample positive. Isolates were uniformly resistant to fluconazole, 20 isolates were resistant to echinocandins (2.8%) and four isolates were resistant to ampfotericin B (0.6%). There were 86 candidemia cases. APACHE II, digestive disease and catheter isolate were proven to be independent risk factors for developing candidemia in previously colonised patients. Thirty-day mortality rate for C. auris candidemia cases was 32.6%, while for colonisation cases was 33.7%. CONCLUSIONS Candidemia was one of the most frequent and severe infections caused by C. auris. The risk factors identified in this study should help to detect patients who are at more risk of developing candidemia, as long as an adequate surveillance of C. auris colonisation is performed.
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Affiliation(s)
- Juan Vicente Mulet Bayona
- Department of Microbiology and Parasitology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Nuria Tormo Palop
- Department of Microbiology and Parasitology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Carme Salvador García
- Department of Microbiology and Parasitology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Concepción Gimeno Cardona
- Department of Microbiology and Parasitology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
- Department of Microbiology and Ecology, University of Valencia, Valencia, Spain
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50
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Carty J, Chowdhary A, Bernstein D, Thangamani S. Tools and techniques to identify, study, and control Candida auris. PLoS Pathog 2023; 19:e1011698. [PMID: 37856418 PMCID: PMC10586630 DOI: 10.1371/journal.ppat.1011698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Candida auris, is an emerging fungal pathogen that can cause life-threatening infections in humans. Unlike many other Candida species that colonize the intestine, C. auris most efficiently colonizes the skin. Such colonization contaminates the patient's environment and can result in rapid nosocomial transmission. In addition, this transmission can lead to outbreaks of systemic infections that have mortality rates between 40% and 60%. C. auris isolates resistant to all known classes of antifungals have been identified and as such, understanding the underlying biochemical mechanisms of how skin colonization initiates and progresses is critical to developing better therapeutic options. With this review, we briefly summarize what is known about horizontal transmission and current tools used to identify, understand, and control C. auris infections.
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Affiliation(s)
- James Carty
- Department of Biology, Ball State University, Muncie, Indiana, United States of America
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Douglas Bernstein
- Department of Biology, Ball State University, Muncie, Indiana, United States of America
| | - Shankar Thangamani
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, United States of America
- Purdue Institute for Immunology, Inflammation and Infectious Diseases (PI4D), Indiana, United States of America
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