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
Potential conflicts of interest Grant support: Astellas, Basilea, F2G, Merck Consultant: Basilea, Merck, Scynexis Speaker fees: Gilead, Merck, Pfizer, United Medical, Teva
Candida auris: driving soon to a hospital near you
Antifungal resistance is bad, very bad, Candida auris is bad, maybe baddder, than bacteria Candida auris very bad, very bad Japanese fungus I fully support @TalkAMR@Curitiba taking care of this! #InFocus
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.
2014
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
Outbreak at a UK hospital: 2015-2016
Profound phylogeographic clades Very high clonality within the geographic clades Huge genetic differences among geographic clades Recent independent emergence in different places
Mutations in ERG11 gene were geographically distinct Lockhart et al., 2017, CID
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
2016; 59: 535-538 Mizusawa et al. 2017, JCM
2017; 55:2445 2452 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 CAS08-0577; VPCI,Vallabhbhai Patel Chest Institute.
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 1996 2008 2009 2011 2014 2013 2015 2016 2017
Belgium
Belgium, patient from Kuwait
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
2017; 61:e00485-17 123 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).
CDC issued a clinical alert to healthcare facilities July 2016
Public Health England released an alert on the same day in July 2016
C. auris in the U.S. As of August 31 2016, 7 cases detected in USA All retrospectively found except for 1 Summarized in MMWR November 4 2016
KPC story: 1996 A clinical rarity became a disaster
February 2017 New York: 42 (28 cases, 14 colonized) New Jersey: 2 Maryland: 1 (resident of NJ) Illinois: 6 (3 cases, 3 colonized) https://www.cdc.gov/fungal/diseases/candidiasis/candida-auris.html From 1 USA case in July 2016, to >150 in 31 August 2017
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
Where does C auris come from?
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
30 JUNE 4 JULY 2018 RAI AMSTERDAM, THE NETHERLANDS 20 TH CONGRESS OF THE INTERNATIONAL SOCIETY FOR HUMAN AND ANIMAL MYCOLOGY (ISHAM) WWW.ISHAM2018.ORG