Candida auris in various hospitals across Kuwait and their susceptibility and molecular basis of resistance to antifungal drugs
Candida auris in various hospitals across Kuwait and their susceptibility and molecular basis of resistance to antifungal drugs
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DOI：
10.1111/myc.13022
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发表时间：
2020-01-01
期刊：
影响因子：
4.9
通讯作者：
Joseph, Leena
中科院分区：
文献类型：
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作者：
Ahmad, Suhail;Khan, Ziauddin;Joseph, Leena
背景：耳念珠菌是一种多重耐药菌，尽管经过了正常的消毒程序，仍有院内传播的倾向。在这里，我们描述了2014-2018年期间从科威特各医院的患者中分离出的耳念珠菌。同时研究了抗真菌药物的敏感性及对氟康唑、伏立康唑和米卡芬净耐药的分子基础。方法对8所医院126例患者的耳念珠菌314株进行分析。所有分离株均通过PCR扩增和/或核糖体DNA（rDNA）PCR测序鉴定。Etest法测定药物敏感性。分别通过ERG 11和FKS 1基因的PCR测序来研究对氟康唑和米卡芬净耐药的分子基础。结果血液（n = 58），尿液（n = 124），呼吸道（n = 98）和其他（n = 34）标本产生314耳念珠菌分离株。2018年，所有酵母菌分离株中的血流耳念珠菌比例（307株中的42株，13.7%）高于2014-2017年（964株中的16株，1.7%）（P = .001）。2018年培养的血流分离株（139株中的42株）比2014-2017年（175株中的16株）多（P = .001）。对红霉素B、氟康唑、伏立康唑和米卡芬净的耐药率分别为27.1%、100%、41.1%和1.7%。氟康唑耐药菌株含有ERG 11的Y132 F或K143 R突变。携带K143 R突变的菌株对伏立康唑也耐药。米卡芬净耐药菌株在FKS 1的热点1处存在S639 F突变。结论我们的研究强调了耳念珠菌在科威特各大医院的传播及其在2018年作为血流病原体的作用日益增加。对伏立康唑的交叉耐药也见于ERG 11中K143 R突变的分离株，而米卡芬净耐药分离株则含有FKS 1热点1中S639 F突变。
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.