Molecular Epidemiology of Candida auris in Colombia Reveals a Highly Related, Countrywide Colonization With Regional Patterns in Amphotericin B Resistance
Molecular Epidemiology of Candida auris in Colombia Reveals a Highly Related, Countrywide Colonization With Regional Patterns in Amphotericin B Resistance
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DOI：
10.1093/cid/ciy411
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发表时间：
2019-01-01
影响因子：
11.8
通讯作者：
Chiller, Tom M.
中科院分区：
文献类型：
--
作者：
Escandon, Patricia;Chow, Nancy A.;Chiller, Tom M.
背景耳念珠菌是一种多药耐药酵母菌，与全球医院爆发有关。2015-2016年期间，哥伦比亚报告了多起疫情。我们的目的是了解医疗机构的污染程度，并描述C。方法.我们对4所医院的病人、病人接触者、医护人员和环境进行了抽样调查。耳疾爆发。使用标准化的协议，人们在不同的身体部位擦拭。将患者和手术室分成4个区域，并擦拭表面。我们对所有分离株进行了全基因组测序（WGS）和抗真菌药敏试验（AFST）。17人中有7人（41%）被发现是殖民地。从322份环境样品中分离出耳念珠菌37份（11%）。这些是从所有4个区域的各种物品中收集的。WGS和AFST显示，尽管全国各地的分离株相似，但来自北方地区的分离株在遗传上不同，并且比来自哥伦比亚中部的分离株对阿替霉素B（AmB）更具耐药性。发现4个新的非同义突变与AmB耐药显著相关。我们的结果表明，广泛的C。耳污染可能发生，并强调遵守适当的感染控制措施和消毒策略的重要性。观察到的遗传多样性支持医疗传播和最近C。哥伦比亚境内的auris，AmB易感性不同。
Background. Candida auris is a multidrug-resistant yeast associated with hospital outbreaks worldwide. During 2015-2016, multiple outbreaks were reported in Colombia. We aimed to understand the extent of contamination in healthcare settings and to characterize the molecular epidemiology of C. auris in Colombia.Methods. We sampled patients, patient contacts, healthcare workers, and the environment in 4 hospitals with recent C. auris outbreaks. Using standardized protocols, people were swabbed at different body sites. Patient and procedure rooms were sectioned into 4 zones and surfaces were swabbed. We performed whole-genome sequencing (WGS) and antifungal susceptibility testing (AFST) on all isolates.Results. Seven of the 17 (41%) people swabbed were found to be colonized. Candida auris was isolated from 37 of 322 (11%) environmental samples. These were collected from a variety of items in all 4 zones. WGS and AFST revealed that although isolates were similar throughout the country, isolates from the northern region were genetically distinct and more resistant to amphotericin B (AmB) than the isolates from central Colombia. Four novel nonsynonymous mutations were found to be significantly associated with AmB resistance.Conclusions. Our results show that extensive C. auris contamination can occur and highlight the importance of adherence to appropriate infection control practices and disinfection strategies. Observed genetic diversity supports healthcare transmission and a recent expansion of C. auris within Colombia with divergent AmB susceptibility.