Clonal Dissemination of Antifungal-Resistant Candida haemulonii, China

• Published in: Emerging infectious diseases Vol. 29; no. 3; pp. 576 - 584
• Main Authors: Chen, Xinfei, Jia, Xinmiao, Bing, Jian, Zhang, Han, Hong, Nan, Liu, Yun, Xi, Haiyang, Wang, Weiping, Liu, Zhiyong, Zhang, Qiangqiang, Li, Li, Kang, Mei, Xiao, Yuling, Yang, Bin, Lin, Yulan, Xu, Hui, Fan, Xin, Huang, Jingjing, Gong, Jie, Xu, Juan, Xie, Xiuli, Yang, Wenhang, Zhang, Ge, Zhang, Jingjia, Kang, Wei, Wang, He, Hou, Xin, Xiao, Meng, Xu, Yingchun
• Format: Journal Article
• Language: English
• Published: United States U.S. National Center for Infectious Diseases 01.03.2023; Centers for Disease Control and Prevention
• Subjects: Analysis; Antifungal agents; Antifungal Agents - therapeutic use; antifungal resistance; Candida; Candida - drug effects; Candida - genetics; Candida haemulonii; Candidiasis - drug therapy; Candidiasis - genetics; Candidiasis - microbiology; Caspofungin; Catheters; Cerebrospinal fluid; China; clonal dissemination; Clonal Dissemination of Antifungal-Resistant; Clone Cells; Distribution; Drug resistance in microorganisms; Drug Resistance, Fungal - genetics; Emergency medical care; Epidemics; Fungal infections; Genetic aspects; Genomes; Genomics; Hospitals; Identification and classification; Intensive care; Microbial Sensitivity Tests; multidrug resistance; Phylogenetics; Phylogeny; Polymorphism; Posaconazole; Single nucleotide polymorphisms; Surveillance; whole-genome sequencing; China; multidrug resistance; antimicrobial resistance; fungi; China; whole-genome sequencing; Candida haemulonii; clonal dissemination; antifungal resistance
• ISSN: 1080-6040; 1080-6059
• DOI: 10.3201/eid2903.221082

Candida haemulonii, a relative of C. auris, frequently shows antifungal resistance and is transmissible. However, molecular tools for genotyping and investigating outbreaks are not yet established. We performed genome-based population analysis on 94 C. haemulonii strains, including 58 isolates from China and 36 other published strains. Phylogenetic analysis revealed that C. haemulonii can be divided into 4 clades. Clade 1 comprised strains from China and other global strains; clades 2-4 contained only isolates from China, were more recently evolved, and showed higher antifungal resistance. Four regional epidemic clusters (A, B, C, and D) were identified in China, each comprising ≥5 cases (largest intracluster pairwise single-nucleotide polymorphism differences <50 bp). Cluster A was identified in 2 hospitals located in the same city, suggesting potential intracity transmissions. Cluster D was resistant to 3 classes of antifungals. The emergence of more resistant phylogenetic clades and regional dissemination of antifungal-resistant C. haemulonii warrants further monitoring.