Genotypic and phenotypic characterisation of a nosocomial outbreak of Candida auris in Spain during 5 years.

IF 4.1 2区医学 Q1 DERMATOLOGY Mycoses Pub Date : 2024-08-01 DOI:10.1111/myc.13776

Juan Vicente Mulet-Bayona, Irving Cancino-Muñoz, Carme Salvador-García, Nuria Tormo-Palop, María Del Remedio Guna-Serrano, Carolina Ferrer-Gómez, Mercedes Melero-García, Fernando González-Candelas, Concepción Gimeno-Cardona

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Abstract

Objectives: The investigation of Candida auris outbreaks is needed to provide insights into its population structure and transmission dynamics. We genotypically and phenotypically characterised a C. auris nosocomial outbreak occurred in Consorcio Hospital General Universitario de Valencia (CHGUV), Spain.

Methods: Data and isolates were collected from CHGUV from September 2017 (first case) until September 2021. Thirty-five isolates, including one from an environmental source, were randomly selected for whole genome sequencing (WGS), and the genomes were analysed along with a database with 335 publicly available genomes, assigning them to one of the five major clades. In order to identify polymorphisms associated with drug resistance, we used the fully susceptible GCA_003014415.1 strain as reference sequence. Known mutations in genes ERG11 and FKS1 conferring resistance to fluconazole and echinocandins, respectively, were investigated. Isolates were classified into aggregating or non-aggregating.

Results: All isolates belonged to clade III and were from an outbreak with a single origin. They clustered close to three publicly available genomes from a hospital from where the first patient was transferred, being the probable origin. The mutation VF125AL in the ERG11 gene, conferring resistance to fluconazole, was present in all the isolates and one isolate also carried the mutation S639Y in the FKS1 gene. All the isolates had a non-aggregating phenotype (potentially more virulent).

Conclusions: Isolates are genotypically related and phenotypically identical but one with resistance to echinocandins, which seems to indicate that they all belong to an outbreak originated from a single isolate, remaining largely invariable over the years. This result stresses the importance of implementing infection control practices as soon as the first case is detected or when a patient is transferred from a setting with known cases.

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西班牙 5 年内爆发的念珠菌疫情的基因型和表型特征。

目的：为了深入了解念珠菌的种群结构和传播动态，需要对念珠菌疫情进行调查。我们对西班牙瓦伦西亚大学总医院（CHGUV）爆发的念珠菌病进行了基因型和表型鉴定：从2017年9月（首例病例）至2021年9月，从CHGUV收集了数据和分离株。随机选取了 35 个分离株（包括一个来自环境的分离株）进行全基因组测序（WGS），并将其基因组与包含 335 个公开基因组的数据库一起进行分析，将其归入五大支系之一。为了确定与耐药性相关的多态性，我们使用了完全易感的 GCA_003014415.1 株作为参考序列。我们研究了ERG11和FKS1基因中分别赋予氟康唑和棘白菌素耐药性的已知突变。将分离株分为聚集型和非聚集型：结果：所有分离株都属于第三支系，来自一次单一来源的疫情。它们聚集在三个公开的基因组附近，这三个基因组来自一家医院，而第一名患者就是从这家医院转出的，因此这三个基因组是可能的来源。所有分离株中都存在ERG11基因中的变异VF125AL，该变异可使其对氟康唑产生抗药性，其中一个分离株还携带FKS1基因中的变异S639Y。所有分离株都具有非聚集表型（可能毒性更强）：这些分离物在基因型上相关，表型上相同，但其中一个分离物对棘白菌素具有抗药性，这似乎表明这些分离物都属于由单一分离物引起的疫情，多年来基本保持不变。这一结果强调，一旦发现首例病例，或当病人从已知有病例的环境中转院时，必须立即实施感染控制措施。

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来源期刊

Mycoses 医学-皮肤病学

CiteScore

10.00

自引率

8.20%

发文量

143

审稿时长

6-12 weeks

期刊介绍： The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi. Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.