title: Multidrug-resistant endemic clonal strain of Candida auris in India.
abstract: Candida auris is a recently described rare agent of fungemia. It is notable for its antifungal resistance. A total of 15 C. auris isolates, originating from seven cases of fungemia, three cases of diabetic gangrenous foot, and one case of bronchopneumonia from a tertiary care hospital in south India, were investigated. All of the 15 isolates were identified by sequencing and 14 of these along with 12 C. auris isolates previously reported from two hospitals in Delhi, north India, two each from Japan and Korea were genotyped by amplified fragment length polymorphism (AFLP). In vitro antifungal susceptibility testing (AFST) was done by the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method. Candida auris isolates were misidentified as Candida haemulonii by VITEK. All were resistant to fluconazole [geometric mean minimum inhibitory concentration (MIC) 64 μg/ml] and 11 isolates were resistant to voriconazole (MIC ≥1 μg/ml). Forty-seven percent of the C. auris isolates were resistant to flucytosine (MIC ≥64 μg/ml) and 40% had high MIC (≥1 μg/ml) of caspofungin. Breakthrough fungemia developed in 28.6% of patients and therapeutic failure in 4 (66.7%) patients. Interestingly, the 26 Indian C. auris isolates from north and south India were clonal and phenotypically and genotypically distinct from Korean and Japanese isolates. The present study demonstrates that C. auris is a potential emerging pathogen that can cause a wide spectrum of human mycotic infections. The prevalence of a C. auris endemic clonal strain resistant to azoles and other antifungals in Indian hospitals with high rates of therapeutic failure in cases of fungemia is worrisome.
authors.affiliation: Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, 110 007, India, dranuradha@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Chowdhary
authors.forename: V
authors.initials: V
authors.lastname: Anil Kumar
authors.forename: C
authors.initials: C
authors.lastname: Sharma
authors.forename: A
authors.initials: A
authors.lastname: Prakash
authors.forename: K
authors.initials: K
authors.lastname: Agarwal
authors.forename: R
authors.initials: R
authors.lastname: Babu
authors.forename: K R
authors.initials: KR
authors.lastname: Dinesh
authors.forename: S
authors.initials: S
authors.lastname: Karim
authors.forename: S K
authors.initials: SK
authors.lastname: Singh
authors.forename: F
authors.initials: F
authors.lastname: Hagen
authors.forename: J F
authors.initials: JF
authors.lastname: Meis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054458:Amplified Fragment Length Polymorphism Analysis; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D002675:Child, Preschool; D016000:Cluster Analysis; D004271:DNA, Fungal / Q000235:genetics; D026141:Drug Resistance, Multiple, Fungal; D019353:Endemic Diseases; D005260:Female; D005838:Genotype; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058889:Molecular Typing; D016533:Mycological Typing Techniques; D062606:Tertiary Care Centers; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal