Worldwide dispersion of Candida auris: a multiresistant and emergent agent of candidiasis

Transcription

1 Worldwide dispersion of Candida auris: a multiresistant and emergent agent of candidiasis Jacques F. Meis MD Dept. of Medical Microbiology and Infectious Diseases Canisius Wilhelmina Hospital and Radboud Univ. Med. Centre Nijmegen, The Netherlands

2 Potential conflicts of interest Grant support: Astellas, Basilea, F2G, Merck Consultant: Basilea, Merck, Scynexis Speaker fees: Gilead, Merck, Pfizer, United Medical, Teva

3 Candida auris: driving soon to a hospital near you

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5 Antifungal resistance is bad, very bad, Candida auris is bad, maybe baddder, than bacteria Candida auris very bad, very bad Japanese fungus I fully taking care of this! #InFocus

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8 Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an in patient in a Japanese hospital. Satoh K et al. Microbiol Immunol. 2009;53(1):41-4.

9 2014

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11 ØC. auris from 4 Indian hospitals were highly related suggesting clonal transmission ØAll isolates were resistant to fluconazole Results of average nucleotide identity analysis giving percentage similarity between Candida auris

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13 Outbreak at a UK hospital:

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17 Profound phylogeographic clades Very high clonality within the geographic clades Huge genetic differences among geographic clades Recent independent emergence in different places

18 Mutations in ERG11 gene were geographically distinct Lockhart et al., 2017, CID

19 VITEK 2 Compact (biomérieux) API20C-AUX (biomérieux) MicroScan (Beckman Coulter) AuxaColor 2 (BioRad) BD Phoenix (BD) C. haemulonii Rhodotorula glutinis C. famata Saccharomyces cerevisiae C. haemulonii C. famata C. sake C. lusitaniae C. catenulata C. lusitaniae C. famata C. guilliermondii C. parapsilosis C. tropicalis C. albicans

20 2016; 59: Mizusawa et al. 2017, JCM

21 2017; 55: Conventional and real time PCR assays were 100% concordant with the DNA sequencing results Figure: A series: Candida auris-specific PCR;B series, colony Candida aurisspecific PCR; lane 1, negative control; lane 2, C. auris VPCI 671/P/12; lane 3, C. haemulonii ATCC 22991; lane 4, C. duobushaemulonii B09383; lane 5, C. lusitaniae CAS ; VPCI,Vallabhbhai Patel Chest Institute.

22 C. auris rapid emergence since 2009 Wrongly identified Korea Pakistan Japan Korea India S. Africa Kenya Kuwait Pakistan Venezuela Israel UK Colombia Panama U.S.A. Spain Germany Norway Oman Belgium Canada

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24 Belgium, patient from Kuwait

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27 Antifungal susceptibility C. auris 98% resistant to fluconazole (MIC 32 μg/ ml) 54% resistant to voriconazole (MIC 4 μg/ ml) 35% resistant to amphotericin B (>1 μg/ ml) 7% resistant to echinocandins 41% MDR isolates 4% resistant to all three major antifungal classes

28 2017; 61:e Indian isolatestested by CLSI and EUCAST. MICs were remarkably similar. Uniform fluconazole resistance (88% >32 μg/ ml). 10% were amphotericin B resistant (MIC >1 μg/ ml). 7% were echinocandin resistant (MIC >4 μg/ ml).

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30 CDC issued a clinical alert to healthcare facilities July 2016

31 Public Health England released an alert on the same day in July 2016

32 C. auris in the U.S. As of August , 7 cases detected in USA All retrospectively found except for 1 Summarized in MMWR November

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34 KPC story: 1996 A clinical rarity became a disaster

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36 February 2017 New York: 42 (28 cases, 14 colonized) New Jersey: 2 Maryland: 1 (resident of NJ) Illinois: 6 (3 cases, 3 colonized) From 1 USA case in July 2016, to >150 in 31 August 2017

37 Candida auris Causes outbreaks and is transmitted in healthcare settings Unlike other Candida spp., seems to colonize (prolonged) healthcare environments and patients skin (with) Transmission within healthcare environment Major infection control challenges

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39 Where does C auris come from?

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41 What you should know about C. auris Is multi-drug resistant Some isolates resistant to all three major antifungal classes Can be misidentified Usually misidentified as other Candida spp or Saccharomyces, when using biochemical methods (API strips or VITEK-2) MALDI-TOF can detect C. auris Causes outbreaks and is transmitted in healthcare settings Unlike other Candida spp., seems to colonize healthcare environments and skin Transmission within healthcare environment Major infection control challenges

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43 30 JUNE 4 JULY 2018 RAI AMSTERDAM, THE NETHERLANDS 20 TH CONGRESS OF THE INTERNATIONAL SOCIETY FOR HUMAN AND ANIMAL MYCOLOGY (ISHAM)

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