Candida auris in Singapore: Genomic epidemiology, antifungal drug resistance, and identification using the updated 8.01 VITEKⓇ2 system

•ERG11 mutations in Candida auris (C. auris) are clade-specific.•42.9% of C. auris isolated in Singapore is multidrug-resistant.•The updated VITEKⓇ2 System has limited abilities for identifying C. auris.•Genomic data must be correlated with epidemiological information. Candida auris (C. auris) has g...

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Published inInternational journal of antimicrobial agents Vol. 54; no. 6; pp. 709 - 715
Main Authors Tan, Yen Ee, Teo, Jocelyn Qi-Min, Rahman, Nurdyana Binte Abdul, Ng, Oon Tek, Kalisvar, Marimuthu, Tan, Ai Ling, Koh, Tse Hsien, Ong, Rick Twee Hee
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier B.V 01.12.2019
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Abstract •ERG11 mutations in Candida auris (C. auris) are clade-specific.•42.9% of C. auris isolated in Singapore is multidrug-resistant.•The updated VITEKⓇ2 System has limited abilities for identifying C. auris.•Genomic data must be correlated with epidemiological information. Candida auris (C. auris) has globally emerged as a multidrug-resistant pathogen. While it is known that there are four geographic clades, little is known about its genomic epidemiology in the Southeast Asian region. Laboratory identification can be challenging but the VITEKⓇ2 system (version 8.01 software) has recently updated its database to include C. auris. This study aimed to investigate the genomic epidemiology of C. auris isolated in Singapore and the susceptibility profiles in relation to ERG11 and FKS1 mutations. Seven C. auris isolates from 2012–2018 were analysed using whole-genome sequencing, and antifungal susceptibility testing was performed. The performance of the updated VITEKⓇ2 system in identifying C. auris was also evaluated using these C. auris strains together with five closely related Candida species. Three clades were identified: South Asian (71.4%), South American (14.3%) and East Asian (14.3%). Local transmission was unlikely as there was no obviously identified cluster and most cases were likely to be imported at different time points following overseas hospitalisation exposure. Three isolates (42.9%) were multidrug-resistant. All South Asian strains were resistant to fluconazole and harboured ERG11 mutations, which were clade-specific. No FKS1 mutation was detected. The VITEKⓇ2 system was able to correctly identify most of the South Asian C. auris strains but misidentified the East Asian strain and gave a low discrimination result for the South American clade. This study showed that the introduction of C. auris into Singapore was possibly over multiple episodes and from different sources. The VITEKⓇ2 System version 8.01 software has limited abilities in identifying C .auris.
AbstractList •ERG11 mutations in Candida auris (C. auris) are clade-specific.•42.9% of C. auris isolated in Singapore is multidrug-resistant.•The updated VITEKⓇ2 System has limited abilities for identifying C. auris.•Genomic data must be correlated with epidemiological information. Candida auris (C. auris) has globally emerged as a multidrug-resistant pathogen. While it is known that there are four geographic clades, little is known about its genomic epidemiology in the Southeast Asian region. Laboratory identification can be challenging but the VITEKⓇ2 system (version 8.01 software) has recently updated its database to include C. auris. This study aimed to investigate the genomic epidemiology of C. auris isolated in Singapore and the susceptibility profiles in relation to ERG11 and FKS1 mutations. Seven C. auris isolates from 2012–2018 were analysed using whole-genome sequencing, and antifungal susceptibility testing was performed. The performance of the updated VITEKⓇ2 system in identifying C. auris was also evaluated using these C. auris strains together with five closely related Candida species. Three clades were identified: South Asian (71.4%), South American (14.3%) and East Asian (14.3%). Local transmission was unlikely as there was no obviously identified cluster and most cases were likely to be imported at different time points following overseas hospitalisation exposure. Three isolates (42.9%) were multidrug-resistant. All South Asian strains were resistant to fluconazole and harboured ERG11 mutations, which were clade-specific. No FKS1 mutation was detected. The VITEKⓇ2 system was able to correctly identify most of the South Asian C. auris strains but misidentified the East Asian strain and gave a low discrimination result for the South American clade. This study showed that the introduction of C. auris into Singapore was possibly over multiple episodes and from different sources. The VITEKⓇ2 System version 8.01 software has limited abilities in identifying C .auris.
Candida auris (C. auris) has globally emerged as a multidrug-resistant pathogen. While it is known that there are four geographic clades, little is known about its genomic epidemiology in the Southeast Asian region. Laboratory identification can be challenging but the VITEK 2 system (version 8.01 software) has recently updated its database to include C. auris. This study aimed to investigate the genomic epidemiology of C. auris isolated in Singapore and the susceptibility profiles in relation to ERG11 and FKS1 mutations. Seven C. auris isolates from 2012-2018 were analysed using whole-genome sequencing, and antifungal susceptibility testing was performed. The performance of the updated VITEK 2 system in identifying C. auris was also evaluated using these C. auris strains together with five closely related Candida species. Three clades were identified: South Asian (71.4%), South American (14.3%) and East Asian (14.3%). Local transmission was unlikely as there was no obviously identified cluster and most cases were likely to be imported at different time points following overseas hospitalisation exposure. Three isolates (42.9%) were multidrug-resistant. All South Asian strains were resistant to fluconazole and harboured ERG11 mutations, which were clade-specific. No FKS1 mutation was detected. The VITEK 2 system was able to correctly identify most of the South Asian C. auris strains but misidentified the East Asian strain and gave a low discrimination result for the South American clade. This study showed that the introduction of C. auris into Singapore was possibly over multiple episodes and from different sources. The VITEK 2 System version 8.01 software has limited abilities in identifying C .auris.
OBJECTIVESCandida auris (C. auris) has globally emerged as a multidrug-resistant pathogen. While it is known that there are four geographic clades, little is known about its genomic epidemiology in the Southeast Asian region. Laboratory identification can be challenging but the VITEKⓇ2 system (version 8.01 software) has recently updated its database to include C. auris. This study aimed to investigate the genomic epidemiology of C. auris isolated in Singapore and the susceptibility profiles in relation to ERG11 and FKS1 mutations. METHODSSeven C. auris isolates from 2012-2018 were analysed using whole-genome sequencing, and antifungal susceptibility testing was performed. The performance of the updated VITEKⓇ2 system in identifying C. auris was also evaluated using these C. auris strains together with five closely related Candida species. RESULTSThree clades were identified: South Asian (71.4%), South American (14.3%) and East Asian (14.3%). Local transmission was unlikely as there was no obviously identified cluster and most cases were likely to be imported at different time points following overseas hospitalisation exposure. Three isolates (42.9%) were multidrug-resistant. All South Asian strains were resistant to fluconazole and harboured ERG11 mutations, which were clade-specific. No FKS1 mutation was detected. The VITEKⓇ2 system was able to correctly identify most of the South Asian C. auris strains but misidentified the East Asian strain and gave a low discrimination result for the South American clade. CONCLUSIONThis study showed that the introduction of C. auris into Singapore was possibly over multiple episodes and from different sources. The VITEKⓇ2 System version 8.01 software has limited abilities in identifying C .auris.
Author Rahman, Nurdyana Binte Abdul
Tan, Yen Ee
Ong, Rick Twee Hee
Kalisvar, Marimuthu
Tan, Ai Ling
Teo, Jocelyn Qi-Min
Ng, Oon Tek
Koh, Tse Hsien
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Keywords Candida auris
Singapore
Genomic epidemiology
Antifungal drug resistance
VITEKⓇ2 (version 8.01)
VITEK(Ⓡ)2 (version 8.01)
Language English
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Snippet •ERG11 mutations in Candida auris (C. auris) are clade-specific.•42.9% of C. auris isolated in Singapore is multidrug-resistant.•The updated VITEKⓇ2 System has...
Candida auris (C. auris) has globally emerged as a multidrug-resistant pathogen. While it is known that there are four geographic clades, little is known about...
OBJECTIVESCandida auris (C. auris) has globally emerged as a multidrug-resistant pathogen. While it is known that there are four geographic clades, little is...
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SubjectTerms Antifungal Agents - pharmacology
Antifungal drug resistance
Candida - drug effects
Candida auris
Candidiasis - epidemiology
Candidiasis - microbiology
Drug Resistance, Fungal
Fungal Proteins - genetics
Fungal Proteins - metabolism
Genome, Fungal
Genomic epidemiology
Humans
Molecular Epidemiology
Phylogeny
Singapore
Singapore - epidemiology
VITEKⓇ2 (version 8.01)
Title Candida auris in Singapore: Genomic epidemiology, antifungal drug resistance, and identification using the updated 8.01 VITEKⓇ2 system
URI https://dx.doi.org/10.1016/j.ijantimicag.2019.09.016
https://www.ncbi.nlm.nih.gov/pubmed/31600556
https://search.proquest.com/docview/2305036230
Volume 54
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