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.

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Acknowledgments

CS is supported by a University Grants Commission Research Fellowship (F.2-15/2003 SA-I). JFM has been supported by Qatar National Research Fund grant NPRP 5-298-3-086.

Conflict of interest

JFM received grants from Astellas, Merck, and Schering-Plough. He has been a consultant to Astellas, Basilea, and Merck, and received speaker’s fees from Merck. All other authors: no potential conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Correspondence to A. Chowdhary.

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Chowdhary, A., Anil Kumar, V., Sharma, C. et al. Multidrug-resistant endemic clonal strain of Candida auris in India. Eur J Clin Microbiol Infect Dis 33, 919–926 (2014). https://doi.org/10.1007/s10096-013-2027-1

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Keywords

  • Minimum Inhibitory Concentration
  • Internal Transcribe Spacer
  • Fluconazole
  • Amplify Fragment Length Polymorphism
  • Voriconazole