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UrduPaper Title: Candida auris Pan-Drug-Resistant to Four Classes of Antifungal Agents
Journal: Antimicrobial Agents and Chemotherapy, June 30, 2022
Authors: Samantha E. Jacobs, MD, Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai; and other coauthors.
Bottom Line: Candida auris is a fungus that can cause severe infection and even death. This novel yeast pathogen is responsible for an ongoing epidemic of healthcare-associated infections in the New York metropolitan area, other parts of the United States, and globally. A team of researchers from the Icahn School of Medicine at Mount Sinai, American Type Culture Collection, and the Wadsworth Center New York State Department of Health conducted genome and drug-resistance analysis of C. auris isolates from a transplant patient to better understand the mechanisms of the fungus and how it displays resistance in some patients.
How: Shortly after a multi-organ transplant, a patient was found to have intra-abdominal infection with C. auris. During the 74-day hospitalization, the C. auris became increasingly resistant, eventually to all four major classes of currently FDA-approved antifungal drugs. The researchers carried out extensive genome analysis of the patient’s C. auris isolates, 19 in total, to identify common and novel genetic changes driving high resistance to this fungus. They also developed a novel genetic test to confirm resistance to multiple drugs.
Results: Genome analysis found drug resistance developed by step-by-step accumulation of several genetic changes. Further, the drug-resistant strains were all isolated from the patient and were not introduced from outside the hospital. All commonly used broad-spectrum antifungal drugs were ineffective. A limited testing with two-drug combinations also did not show any activity against multi-drug-resistant C. auris.
Why the Research Is Interesting: The evolution of drug-resistant C. auris in a patient over time suggests the need for laboratory tests that rapidly determine which antifungal drug or combinations of antifungal drugs are most active. The findings also conclude that high-risk transplant patients may need closer monitoring for Candida auris colonization and infection before and after the transplant.
Said first author Dr. Samantha E. Jacobs of Mount Sinai: The development of pan-drug resistant C. auris in our most vulnerable patients is alarming and bespeaks the need for novel treatments, some of which are currently in clinical trials.
Said senior author Dr. Vishnu Chaturvedi of the Westchester Medical Center: We need further improvements in diagnostics for fungal infections to cope with C. auris, which is turning into a super, super bug.
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