ena-STUDY-Kuwait University-12-05-2019-12:21:45:092-46
Persistence and spread of Candida auris in various hospitals across Kuwait and their susceptibility to antifungal drugs
Background: Candida auris has recently attracted worldwide attention because of its intrinsic resistance to multiple antifungal agents and proclivity of nosocomial transmission despite normal decontamination procedures. Here, we describe isolation frequency and spread of C. auris among patients in various hospitals in Kuwait during 2014-2018. Susceptibility to antifungal drugs and molecular basis of resistance to fluconazole, voriconazole and micafungin was also studied.Methods: A total of 314 C. auris isolates obtained from 126 patients in eight hospitals were studied. All isolates were identified by PCR amplification and/or PCR-sequencing of rDNA. Antifungal susceptibility was determined by Etest. Fluconazole resistance was studied by PCR-sequencing of ERG11 gene fragment while resistance to micafungin was studied by PCR-sequencing of hotspot 1 region of FKS1 gene.Results: Of 314 C. auris isolates, 58 (18.4%) came from blood specimens of 43 patients including 42 strains isolated from 30 patients in 2018. Most non-blood isolates (n=256) were cultured from urine (n=124) and respiratory specimens (n=98). The isolation frequency of bloodstream C. auris strains was statistically higher (42 of 307, 13.7%) in 2018 as compared to 2014-2017 (16 of 964, 1.7%) (P=0.000). Similarly, isolation frequency of C. auris was statistically higher (P=0.000) from non-blood specimens in 2018 (97 of 722, 13.4%) as compared to 2014-2017 (159 of 2847, 6.4%). Of total C. auris isolates during the two period, more bloodstream isolates (42 of 139) were cultured in 2018 than during 2014-2017 (16 of 175) (P=0.000). Resistance to amphotericin B, fluconazole, voriconazole and micafungin was detected in 27.1%, 100%, 41.1% and 1.7% isolates, respectively. No isolate was resistant to flucytosine. Fluconazole-resistant isolates contained either Y132F or K143R mutation in ERG11. Isolates with K143R mutation were additionally resistant to voriconazole. Micafungin-resistant isolates contained S639F mutation in hotspot 1 region of FKS1. Conclusions: Our study highlights continued spread of C. auris in major hospitals across Kuwait and its increasing role as a bloodstream pathogen in 2018 warranting continuous surveillance. Cross-resistance to voriconazole was seen only in isolates with K143R mutation in ERG11 while micafungin-resistant isolates harbored S639F mutation in hotspot 1 of FKS1.
Background: Candida auris has recently attracted worldwide attention because of its intrinsic resistance to multiple antifungal agents and proclivity of nosocomial transmission despite normal decontamination procedures. Here, we describe isolation frequency and spread of C. auris among patients in various hospitals in Kuwait during 2014-2018. Susceptibility to antifungal drugs and molecular basis of resistance to fluconazole, voriconazole and micafungin was also studied.Methods: A total of 314 C. auris isolates obtained from 126 patients in eight hospitals were studied. All isolates were identified by PCR amplification and/or PCR-sequencing of rDNA. Antifungal susceptibility was determined by Etest. Fluconazole resistance was studied by PCR-sequencing of ERG11 gene fragment while resistance to micafungin was studied by PCR-sequencing of hotspot 1 region of FKS1 gene.Results: Of 314 C. auris isolates, 58 (18.4%) came from blood specimens of 43 patients including 42 strains isolated from 30 patients in 2018. Most non-blood isolates (n=256) were cultured from urine (n=124) and respiratory specimens (n=98). The isolation frequency of bloodstream C. auris strains was statistically higher (42 of 307, 13.7%) in 2018 as compared to 2014-2017 (16 of 964, 1.7%) (P=0.000). Similarly, isolation frequency of C. auris was statistically higher (P=0.000) from non-blood specimens in 2018 (97 of 722, 13.4%) as compared to 2014-2017 (159 of 2847, 6.4%). Of total C. auris isolates during the two period, more bloodstream isolates (42 of 139) were cultured in 2018 than during 2014-2017 (16 of 175) (P=0.000). Resistance to amphotericin B, fluconazole, voriconazole and micafungin was detected in 27.1%, 100%, 41.1% and 1.7% isolates, respectively. No isolate was resistant to flucytosine. Fluconazole-resistant isolates contained either Y132F or K143R mutation in ERG11. Isolates with K143R mutation were additionally resistant to voriconazole. Micafungin-resistant isolates contained S639F mutation in hotspot 1 region of FKS1. Conclusions: Our study highlights continued spread of C. auris in major hospitals across Kuwait and its increasing role as a bloodstream pathogen in 2018 warranting continuous surveillance. Cross-resistance to voriconazole was seen only in isolates with K143R mutation in ERG11 while micafungin-resistant isolates harbored S639F mutation in hotspot 1 of FKS1.