Molecular Epidemiology of <i>Candida Auris</i> Outbreak in a Major Secondary-Care Hospital in Kuwait
The emerging, often multidrug-resistant <i>Candida auris</i> is increasingly being associated with outbreaks in healthcare facilities. Here we describe the molecular epidemiology of a <i>C. auris</i> outbreak during 18 months, which started in 2018 in the high dependency unit...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-11-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/6/4/307 |
| _version_ | 1797547183768076288 |
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| author | Wadha Alfouzan Suhail Ahmad Rita Dhar Mohammad Asadzadeh Noura Almerdasi Naglaa M. Abdo Leena Joseph Theun de Groot Walid Q. Alali Ziauddin Khan Jacques F. Meis Mohammad R. Al-Rashidi |
| author_facet | Wadha Alfouzan Suhail Ahmad Rita Dhar Mohammad Asadzadeh Noura Almerdasi Naglaa M. Abdo Leena Joseph Theun de Groot Walid Q. Alali Ziauddin Khan Jacques F. Meis Mohammad R. Al-Rashidi |
| author_sort | Wadha Alfouzan |
| collection | DOAJ |
| description | The emerging, often multidrug-resistant <i>Candida auris</i> is increasingly being associated with outbreaks in healthcare facilities. Here we describe the molecular epidemiology of a <i>C. auris</i> outbreak during 18 months, which started in 2018 in the high dependency unit (HDU) of a secondary-care hospital in Kuwait. Demographic and clinical data for candidemia and colonized patients were prospectively recorded. Clinical and environmental isolates were subjected to phenotypic and molecular identification; antifungal susceptibility testing by broth microdilution method; PCR-sequencing of <i>ERG11</i> and <i>FKS1</i> for resistance mechanisms to triazoles and echinocandins, respectively; and molecular fingerprinting by short tandem repeat (STR) analyses. Seventy-one (17 candidemic and 54 colonized) patients including 26 with candiduria and seven environmental samples yielded <i>C. auris</i>. All isolates were identified as <i>C. auris</i> by Vitek2, MALDI-TOF MS, PCR amplification and/or PCR-sequencing of rDNA. Twelve candidemia and 26 colonized patients were admitted or exposed to HDU. Following outbreak recognition, an intensive screening program was instituted for new patients. Despite treatment of all candidemia and 36 colonized patients, 9 of 17 candidemia and 27 of 54 colonized patients died with an overall crude mortality rate of ~50%. Nearly all isolates were resistant to fluconazole and contained the Y132F mutation in <i>ERG11</i> except one patient’s isolates, which were also distinct by STR typing. Only urine isolates from two patients developed echinocandin resistance with concomitant <i>FKS1</i> mutations. The transmission of <i>C. auris</i> in this outbreak was linked to infected/colonized patients and the hospital environment. However, despite continuous surveillance and enforcement of infection control measures, sporadic new cases continued to occur, challenging the containment efforts. |
| first_indexed | 2024-03-10T14:40:38Z |
| format | Article |
| id | doaj.art-1ef7f713e3eb4a52b22f48dfcf5cbd75 |
| institution | Directory Open Access Journal |
| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-10T14:40:38Z |
| publishDate | 2020-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj.art-1ef7f713e3eb4a52b22f48dfcf5cbd752023-11-20T21:48:35ZengMDPI AGJournal of Fungi2309-608X2020-11-016430710.3390/jof6040307Molecular Epidemiology of <i>Candida Auris</i> Outbreak in a Major Secondary-Care Hospital in KuwaitWadha Alfouzan0Suhail Ahmad1Rita Dhar2Mohammad Asadzadeh3Noura Almerdasi4Naglaa M. Abdo5Leena Joseph6Theun de Groot7Walid Q. Alali8Ziauddin Khan9Jacques F. Meis10Mohammad R. Al-Rashidi11Microbiology Unit, Department of Laboratories, Farwaniya Hospital, P.O. Box 13373, Farwaniya 81004, KuwaitDepartment of Microbiology, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, KuwaitMicrobiology Unit, Department of Laboratories, Farwaniya Hospital, P.O. Box 13373, Farwaniya 81004, KuwaitDepartment of Microbiology, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, KuwaitMicrobiology Unit, Department of Laboratories, Farwaniya Hospital, P.O. Box 13373, Farwaniya 81004, KuwaitDepartment of Infection Control, Farwaniya Hospital, P.O. Box 13373, Farwaniya 81004, KuwaitDepartment of Microbiology, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, KuwaitDepartment of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The NetherlandsDepartment of Epidemiology and Biostatistics, Faculty of Public Health, Kuwait University, P.O. Box 24923, Safat 13110, KuwaitDepartment of Microbiology, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, KuwaitDepartment of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The NetherlandsHospital Administration, Farwaniya Hospital, P.O. Box 13373, Farwaniya 81004, KuwaitThe emerging, often multidrug-resistant <i>Candida auris</i> is increasingly being associated with outbreaks in healthcare facilities. Here we describe the molecular epidemiology of a <i>C. auris</i> outbreak during 18 months, which started in 2018 in the high dependency unit (HDU) of a secondary-care hospital in Kuwait. Demographic and clinical data for candidemia and colonized patients were prospectively recorded. Clinical and environmental isolates were subjected to phenotypic and molecular identification; antifungal susceptibility testing by broth microdilution method; PCR-sequencing of <i>ERG11</i> and <i>FKS1</i> for resistance mechanisms to triazoles and echinocandins, respectively; and molecular fingerprinting by short tandem repeat (STR) analyses. Seventy-one (17 candidemic and 54 colonized) patients including 26 with candiduria and seven environmental samples yielded <i>C. auris</i>. All isolates were identified as <i>C. auris</i> by Vitek2, MALDI-TOF MS, PCR amplification and/or PCR-sequencing of rDNA. Twelve candidemia and 26 colonized patients were admitted or exposed to HDU. Following outbreak recognition, an intensive screening program was instituted for new patients. Despite treatment of all candidemia and 36 colonized patients, 9 of 17 candidemia and 27 of 54 colonized patients died with an overall crude mortality rate of ~50%. Nearly all isolates were resistant to fluconazole and contained the Y132F mutation in <i>ERG11</i> except one patient’s isolates, which were also distinct by STR typing. Only urine isolates from two patients developed echinocandin resistance with concomitant <i>FKS1</i> mutations. The transmission of <i>C. auris</i> in this outbreak was linked to infected/colonized patients and the hospital environment. However, despite continuous surveillance and enforcement of infection control measures, sporadic new cases continued to occur, challenging the containment efforts.https://www.mdpi.com/2309-608X/6/4/307<i>C. auris</i>outbreakFarwaniya HospitalcandidemiacolonizationKuwait |
| spellingShingle | Wadha Alfouzan Suhail Ahmad Rita Dhar Mohammad Asadzadeh Noura Almerdasi Naglaa M. Abdo Leena Joseph Theun de Groot Walid Q. Alali Ziauddin Khan Jacques F. Meis Mohammad R. Al-Rashidi Molecular Epidemiology of <i>Candida Auris</i> Outbreak in a Major Secondary-Care Hospital in Kuwait Journal of Fungi <i>C. auris</i> outbreak Farwaniya Hospital candidemia colonization Kuwait |
| title | Molecular Epidemiology of <i>Candida Auris</i> Outbreak in a Major Secondary-Care Hospital in Kuwait |
| title_full | Molecular Epidemiology of <i>Candida Auris</i> Outbreak in a Major Secondary-Care Hospital in Kuwait |
| title_fullStr | Molecular Epidemiology of <i>Candida Auris</i> Outbreak in a Major Secondary-Care Hospital in Kuwait |
| title_full_unstemmed | Molecular Epidemiology of <i>Candida Auris</i> Outbreak in a Major Secondary-Care Hospital in Kuwait |
| title_short | Molecular Epidemiology of <i>Candida Auris</i> Outbreak in a Major Secondary-Care Hospital in Kuwait |
| title_sort | molecular epidemiology of i candida auris i outbreak in a major secondary care hospital in kuwait |
| topic | <i>C. auris</i> outbreak Farwaniya Hospital candidemia colonization Kuwait |
| url | https://www.mdpi.com/2309-608X/6/4/307 |
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