Two outbreaks and sporadic occurrences of Candida auris from one hospital in China: an epidemiological, genomic retrospective study.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2024-08-26 DOI:10.1007/s15010-024-02378-8

Yulin Zhang, Jiajing Han, Yiqun Ma, Feilong Zhang, Chen Li, Jiankang Zhao, Binghuai Lu, Bin Cao

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引用次数: 0

Abstract

Objectives: To investigate the clinical relevance, origin, transmission, and resistance of Candida auris (C. auris) isolates from two outbreaks and sporadic occurrences from one hospital in China.

Methods: A total of 135 C. auris isolates were collected. Clinical characteristics were obtained and antifungal susceptibility testing (AFST) was performed using the method of broth microdilution. Phylogenetic tree, WGS analysis, and single nucleotide polymorphisms (SNPs) were used to determine the origin, transmission, and resistance mechanisms.

Results: A total of 31 patients (91.2%, 31/34) received invasive medical procedures and 13 patients (38.2%, 13/34) had antifungal agents before C. auris infection/colonization, except one patient whose clinical information was missing. Only 4 cases of C. auris candidemia were observed. 18 patients died, 13 patients recovered, and the outcomes of 3 patients were not available. A total of 35 C. auris isolates, which were successfully cultivated and the first isolated or harbored specific drug-resistant phenotype from each patient, were selected to be sequenced and further analyzed. C. auris isolates presented low genetic variability and belonged to clade I, possibly originating from BJ004-H7 in Beijing. All 35 isolates were resistant to Fluconazole (FCZ) and amphotericin B (AMB), and 3 isolates were resistant to caspofungin (CAS). Mutations in ERG11 and FKS1 were linked to reduced azole and echinocandin susceptibility, respectively.

Conclusions: Two outbreaks of highly clonal, multidrug-resistant C. auris isolates within the medical facility were reported. The intensive performance of disinfection measures helped block in-hospital transmission. Understanding the epidemiology, drug resistance and management of C. auris will be helpful for implementing effective infection control and treatment strategies.

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中国一家医院的两次白色念珠菌爆发和零星发生：一项流行病学和基因组学回顾性研究。

目的调查中国一家医院两次暴发和零星发生的念珠菌病（C. auris）分离株的临床相关性、来源、传播和耐药性：方法：共收集了 135 株念珠菌分离株。方法：共收集了 135 株 C. auris 分离物，获得了临床特征，并采用肉汤微稀释法进行了抗真菌药敏试验（AFST）。利用系统发生树、WGS分析和单核苷酸多态性（SNPs）确定其来源、传播和耐药机制：共有 31 名患者（91.2%，31/34）接受过侵入性医疗程序，13 名患者（38.2%，13/34）在感染/定植 C. auris 之前使用过抗真菌药物，只有一名患者的临床信息缺失。仅观察到 4 例 C. auris 念珠菌血症。18 名患者死亡，13 名患者康复，3 名患者的结果不详。研究人员共选取了 35 个成功培养的念珠菌分离株，对每个患者的第一个分离株或带有特定耐药表型的念珠菌分离株进行了测序和进一步分析。C. auris分离株的遗传变异性较低，属于I支系，可能源自北京的BJ004-H7。所有35个分离株都对氟康唑（FCZ）和两性霉素B（AMB）耐药，3个分离株对卡泊芬净（CAS）耐药。ERG11和FKS1的突变分别与对唑类和棘球霉素的敏感性降低有关：结论：据报道，在医疗机构内爆发了两起高度克隆、耐多种药物的阿氏杆菌分离病例。强化消毒措施有助于阻止院内传播。了解法氏囊病的流行病学、耐药性和管理方法将有助于实施有效的感染控制和治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.