Multidrug-resistant endemic clonal strain of Candida auris in India
Multidrug-resistant endemic clonal strain of Candida auris in India
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DOI：
10.1007/s10096-013-2027-1
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发表时间：
2014-06-01
影响因子：
4.5
通讯作者：
Meis, J. F.
中科院分区：
文献类型：
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作者：
Chowdhary, A.;Kumar, V. Anil;Meis, J. F.
耳念珠菌是一种罕见的真菌血症。它以其抗真菌性而闻名。共15个C。对来自印度南部一家三级保健医院的7例真菌血症、3例糖尿病坏疽足和1例支气管肺炎的耳内分离株进行了研究。所有15个分离株均经测序鉴定，其中沿着的14个分离株与12个C.采用扩增片段长度多态性（AFLP）技术对印度北部德里两所医院的耳道分离株进行了基因分型。体外抗真菌药敏试验（AFST）采用临床和实验室标准化研究所（CLSI）肉汤微量稀释法。VITEK将耳念珠菌分离株误鉴定为海穆隆念珠菌。所有菌株均对氟康唑耐药[几何平均最小抑菌浓度（MIC）64 μ g/ml]，11株菌株对伏立康唑耐药（MIC a份/千日元1 μ g/ml）。47%的C.耳分离株对氟胞嘧啶耐药（MIC为a/1000日元64 μ g/ml），40%的分离株对卡泊芬净具有高MIC（a/1000日元1 μ g/ml）。28.6%的患者发生了突破性真菌血症，4例（66.7%）患者治疗失败。有趣的是，26个印度C。来自印度北部和南部的auris分离株与韩国和日本分离株具有克隆性、表型和基因型差异。本研究表明，C.耳炎是一种潜在的新兴病原体，可引起广泛的人类肌肉感染。C.在印度医院中，真菌血症病例的治疗失败率很高，对唑类和其他抗真菌药物具有耐药性的耳流行性克隆菌株令人担忧。
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 mu g/ml] and 11 isolates were resistant to voriconazole (MIC a parts per thousand yen1 mu g/ml). Forty-seven percent of the C. auris isolates were resistant to flucytosine (MIC a parts per thousand yen64 mu g/ml) and 40 % had high MIC (a parts per thousand yen1 mu g/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.