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Candida auris in various hospitals across Kuwait and their susceptibility and molecular basis of resistance to antifungal drugs.
Mycoses 2019M

Abstract

BACKGROUND

Candida auris, a multidrug-resistant species, has the propensity of nosocomial transmission despite normal decontamination procedures. Here, we describe the isolation of C auris from patients in various hospitals in Kuwait during 2014-2018. Susceptibility to antifungal drugs and molecular basis of resistance to fluconazole, voriconazole and micafungin were also studied.

METHODS

Candida auris (n = 314) obtained from 126 patients in eight hospitals were studied. All isolates were identified by PCR amplification and/or PCR-sequencing of ribosomal DNA (rDNA). Antifungal susceptibility was determined by Etest. Molecular basis of resistance to fluconazole and micafungin was studied by PCR-sequencing of ERG11 and FKS1 genes, respectively.

FINDINGS

Bloodstream (n = 58), urine (n = 124), respiratory (n = 98) and other (n = 34) specimens yielded 314 C auris isolates. The proportion of bloodstream C auris among all yeast isolates was higher (42 of 307, 13.7%) in 2018 as compared to 2014-2017 (16 of 964, 1.7%) (P = .001). More bloodstream isolates (42 of 139) were cultured in 2018 than during 2014-2017 (16 of 175) (P = .001). Resistance to amphotericin B, fluconazole, voriconazole and micafungin was detected in 27.1%, 100%, 41.1% and 1.7% isolates, respectively. 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 hot spot 1 of FKS1.

CONCLUSIONS

Our study highlights spreading of C auris in major hospitals across Kuwait and its increasing role as a bloodstream pathogen in 2018. Cross-resistance to voriconazole was also seen in isolates with K143R mutation in ERG11, while micafungin-resistant isolates harboured S639F mutation in hot spot 1 of FKS1.

Authors+Show Affiliations

Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait.Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait.Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait.Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait.Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31618799

Citation

Ahmad, Suhail, et al. "Candida Auris in Various Hospitals Across Kuwait and Their Susceptibility and Molecular Basis of Resistance to Antifungal Drugs." Mycoses, 2019.
Ahmad S, Khan Z, Al-Sweih N, et al. Candida auris in various hospitals across Kuwait and their susceptibility and molecular basis of resistance to antifungal drugs. Mycoses. 2019.
Ahmad, S., Khan, Z., Al-Sweih, N., Alfouzan, W., & Joseph, L. (2019). Candida auris in various hospitals across Kuwait and their susceptibility and molecular basis of resistance to antifungal drugs. Mycoses, doi:10.1111/myc.13022.
Ahmad S, et al. Candida Auris in Various Hospitals Across Kuwait and Their Susceptibility and Molecular Basis of Resistance to Antifungal Drugs. Mycoses. 2019 Oct 16; PubMed PMID: 31618799.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Candida auris in various hospitals across Kuwait and their susceptibility and molecular basis of resistance to antifungal drugs. AU - Ahmad,Suhail, AU - Khan,Ziauddin, AU - Al-Sweih,Noura, AU - Alfouzan,Wadha, AU - Joseph,Leena, Y1 - 2019/10/16/ PY - 2019/09/02/received PY - 2019/10/10/revised PY - 2019/10/12/accepted PY - 2019/10/17/pubmed PY - 2019/10/17/medline PY - 2019/10/17/entrez KW - Candida auris KW - Kuwait hospitals KW - antifungal susceptibility KW - bloodstream infections KW - resistance mechanism JF - Mycoses JO - Mycoses N2 - BACKGROUND: Candida auris, a multidrug-resistant species, has the propensity of nosocomial transmission despite normal decontamination procedures. Here, we describe the isolation of C auris from patients in various hospitals in Kuwait during 2014-2018. Susceptibility to antifungal drugs and molecular basis of resistance to fluconazole, voriconazole and micafungin were also studied. METHODS: Candida auris (n = 314) obtained from 126 patients in eight hospitals were studied. All isolates were identified by PCR amplification and/or PCR-sequencing of ribosomal DNA (rDNA). Antifungal susceptibility was determined by Etest. Molecular basis of resistance to fluconazole and micafungin was studied by PCR-sequencing of ERG11 and FKS1 genes, respectively. FINDINGS: Bloodstream (n = 58), urine (n = 124), respiratory (n = 98) and other (n = 34) specimens yielded 314 C auris isolates. The proportion of bloodstream C auris among all yeast isolates was higher (42 of 307, 13.7%) in 2018 as compared to 2014-2017 (16 of 964, 1.7%) (P = .001). More bloodstream isolates (42 of 139) were cultured in 2018 than during 2014-2017 (16 of 175) (P = .001). Resistance to amphotericin B, fluconazole, voriconazole and micafungin was detected in 27.1%, 100%, 41.1% and 1.7% isolates, respectively. 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 hot spot 1 of FKS1. CONCLUSIONS: Our study highlights spreading of C auris in major hospitals across Kuwait and its increasing role as a bloodstream pathogen in 2018. Cross-resistance to voriconazole was also seen in isolates with K143R mutation in ERG11, while micafungin-resistant isolates harboured S639F mutation in hot spot 1 of FKS1. SN - 1439-0507 UR - https://www.unboundmedicine.com/medline/citation/31618799/Candida_auris_in_various_hospitals_across_Kuwait_and_their_susceptibility_and_molecular_basis_of_resistance_to_antifungal_drugs L2 - https://doi.org/10.1111/myc.13022 DB - PRIME DP - Unbound Medicine ER -