Abstract
BackgroundThe globally emerging Candida auris pathogens poses heavy burden to the healthcare system. Their molecular analyses assist in understanding their epidemiology, dissemination, treatment, and control. This study was warranted to describe the genomic features and drug resistance profiles using whole genome sequencing (WGS) among C. auris isolates from Lebanon.MethodsA total of 28 C. auris clinical isolates, from different hospital units, were phenotypically identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) and tested for antifungal resistance using Vitek-2 system and E test. The complete genomes were determined by WGS using long reads sequencing (PacBio) to reveal the clade distribution and antifungal resistance genes.ResultsCandida auris revealed uniform resistance to fluconazole and amphotericin B, with full susceptibility to echinocandins. Among key resistance genes studied, only two mutations were detected: Y132F in ERG11 gene and a novel mutation, D709E, found in CDR1 gene encoding for an ABC efflux pump. Phylogenetically, C. auris genomes belonged to South Asian clade I and showed limited genetic diversity, suggesting person to person transmission.ConclusionThis characterization of C. auris isolates from Lebanon revealed the exclusivity of clade I lineage together with uniform resistance to fluconazole and amphotericin B. The control of such highly resistant pathogen necessitates an appropriate and rapid recovery and identification to contain spread and outbreaks.
Highlights
Candida auris has been an emerging fungal infection, characterized by high transmissibility, multidrug resistance, and poor outcomes
The distribution of patients based on their clinical hospital location were nine in intensive care unit (ICU), two in respiratory care unit (RCU), four in coronary care unit (CCU), one in neuro
Among the triazole class drugs, C. auris was considered to be uniformly resistant to fluconazole, only 54% of the isolates showed clear resistance to fluconazole (MICs ≥ 32 μg/ml), while 46% of these isolates revealed a level close to the resistance values, an minimum inhibitory concentrations (MICs) of 16 μg/ml
Summary
Candida auris has been an emerging fungal infection, characterized by high transmissibility, multidrug resistance, and poor outcomes. As such, it is posing serious nosocomial health concerns globally (Forsberg et al, 2019). Whole-genome sequencing (WGS)-based methods have increasingly been used to detect and characterize phylogeographic types and transmission dynamics for this emerging pathogen (Lockhart et al, 2017). The globally emerging Candida auris pathogens poses heavy burden to the healthcare system. Their molecular analyses assist in understanding their epidemiology, dissemination, treatment, and control. This study was warranted to describe the genomic features and drug resistance profiles using whole genome sequencing (WGS) among C. auris isolates from Lebanon
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