scholarly journals The performance of two novel chromogenic media for the identification of multi-drug resistant Candida auris compared with other commercially available formulations

2021 ◽  
Author(s):  
Auke W. de Jong ◽  
Chendo Dieleman ◽  
Mauricio Carbia ◽  
Ratna Mohd Tap ◽  
Ferry Hagen
Keyword(s):  
Common Species ◽  
Multidrug Resistant ◽  
Drug Resistant ◽  
Candida Auris ◽  
Resistant Species ◽  
Detection And Identification ◽  
Selective Agar ◽  
The Media ◽  
Similar Appearance ◽  
Species Specific

Non-albicans Candida species are emerging in the nosocomial environment, with the multidrug-resistant species Candida auris being the most notorious example. Consequently, rapid and accurate species identification has become essential. The objective of this study was to evaluate five commercially available chromogenic media for the presumptive identification of C. auris. Two novel chromogenic formulations, CHROMagarTM Candida Plus (Chromagar) and HiCromeTM C. auris MDR Selective Agar (HiMedia), and three reference media, CandiSelectTM (Bio-Rad), CHROMagarTM Candida (Chromagar), and ChromaticTM Candida (Liofilchem) were inoculated with a collection of 9 genetically diverse C. auris strains and 35 strains from closely related comparator species. After 48h of incubation the media were evaluated for their ability to detect and identify C. auris. All media had the same limitations in the differentiation of the more common species Candida dubliniensis and Candida glabrata. Only on CHROMagarTM Candida Plus, C. auris colonies developed a species-specific coloration. Nevertheless, the closely related pathogenic species Candida pseudohaemulonii and Candida vulturna developed a similar appearance as C. auris on this medium. CHROMagarTM Candida Plus showed to be superior in the detection and identification of C. auris, with 100% inclusivity for C. auris compared to 0% and 33% for the reference media and HiCromeTM C. auris MDR Selective agar, respectively. Although C. vulturna and C. pseudohaemulonii can cause false positives, CHROMagarTM Candida Plus showed to be a valuable addition to the plethora of mostly molecular methods for C. auris detection and identification.

scholarly journals 1579. Multidrug-Resistant Candida auris Isolates From New York Hospitals and Healthcare Facilities Are Susceptible to Antifungal Combinations

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S576-S577
Author(s):  
Brittany O’Brien ◽  
Sudha Chaturvedi ◽  
Vishnu Chaturvedi
Keyword(s):  
New York ◽  
Diagnostic System ◽  
Multidrug Resistant ◽  
Drug Combinations ◽  
Antifungal Drugs ◽  
Drug Resistant ◽  
Candida Auris ◽  
Current Case ◽  
Healthcare Facilities ◽  
Broth Microdilution Method

Abstract Background Candida auris outbreak continues unabated in New York with the current case counts exceeding 300 patients. We used a modification of standard CLSI broth microdilution method (BMD) if two-drug combinations are efficacious against C. auris isolates with high-resistance to fluconazole (FZ, MIC50 >256 mg/L), and variable resistance to other broad-spectrum antifungal drugs. Methods BMD plates were custom-designed and quality controlled by TREK Diagnostic System. The combination tests of 15 drug-resistant C. auris involved microtiter wells with the initial 144 two-drug combinations and their two-fold dilutions (1/2–1/32) to get 864 two-drug combinations finally. We utilized MIC100 endpoints for the drug combination readings as reported earlier for the intra- and inter-laboratory agreements obtained against Candida species and Aspergillus fumigatus (Antimicrob Agents Chemother. 2015. 59:1759–1766). We also tested minimum fungicidal concentrations (MFC). Results We tested all possible 864 two-drug antifungal combinations for nine antifungal drugs in use to yield 12,960 MIC100 readings, and MFC readings for 15 C. auris isolates. Flucytosine (FLC) at 2.0 mg/L potentiated most successful combinations with other drugs. Micafungin (MFG), Anidulafungin (AFG), Caspofungin (CAS) at individual concentrations of 0.25 mg/L combined well with FLC (2.0 mg/L) to yield MIC100 for 14, 13, and 12 of 15 C. auris isolates tested, respectively. MFG/FLC combination was also fungicidal for 4 of 15 isolates. AMB / FLC (0.25/1.0 mg/L) yielded MIC100 for 13 isolates and MFC for three test isolates. Posaconazole (POS), and Isavuconazole (ISA) and Voriconazole (VRC) also combined well with FLC (0.25/2.0 mg/L) to yield MIC100 for 12, 13, and 13 isolates, respectively. POS/FLC combination was fungicidal for three isolates. Conclusion We identified seven two drug-combinations of antifungals efficacious against drug-resistant C. auris strains. The modified BMD combination susceptibility testing could be used by the clinical laboratories to assist providers with the selection of optimal treatment for C. auris candidemia. Disclosures All authors: No reported disclosures.

scholarly journals Environmental Contamination with Candida Species in Multiple Hospitals Including a Tertiary Care Hospital with a Candida auris Outbreak

2019 ◽  
Vol 4 (2) ◽  
pp. 260 ◽  
Author(s):  
Jessica Ann Kumar ◽  
Brandon Eilertson ◽  
Jennifer L. Cadnum ◽  
Chauna S. Whitlow ◽  
Annette L. Jencson ◽  
...  
Keyword(s):  
Environmental Contamination ◽  
Candida Species ◽  
Tertiary Care ◽  
Common Species ◽  
Multidrug Resistant ◽  
Care Hospital ◽  
Limited Information ◽  
Portable Equipment ◽  
Candida Auris ◽  
Cleaning And Disinfection

Background: Environmental sources have been implicated as a potential source for exogenous acquisition of Candida species, particularly the emerging multidrug-resistant Candida auris. However, limited information is available on environmental reservoirs of Candida species in healthcare facilities.Methods: During a 6-month period, cultures for Candida species were collected from high-touch surfaces in patient rooms and from portable equipment in 6 US acute care hospitals in 4 states. Additional cultures were collected from sink drains and floors in one of the hospitals and from high-touch surfaces, portable equipment, and sink drains in a hospital experiencing an outbreak due to C. auris. Candida species were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectometry.Results: Candida species were recovered from patient rooms in 4 of the 6 hospitals. Seven of 147 patient room cultures (4.8%) and 1 of 57 (1.8%) portable equipment cultures were positive, with the most common species being C. parapsilosis. For the hospital where additional sites were sampled, Candida species were recovered from 8 of 22 (36.4%) hospital room floors and 4 of 17 (23.5%) sink drains. In the facility with a C. auris outbreak, Candida species were frequently recovered from sink drains (20.7%) and high-touch surfaces (15.4%), but recovery of C. auris was uncommon (3.8% of high-touch surfaces, 3.4% of sink drains, and 0% of portable equipment) and only present in rooms that currently or recently housed a patient with C. auris.Conclusion: Candida species often contaminate surfaces in hospitals and may be particularly common on floors and in sink drains. However, C. auris contamination was uncommon in a facility experiencing an outbreak, suggesting that current cleaning and disinfection practices can be effective in minimizing environmental contamination.

scholarly journals Fungicidal Potency and Mechanisms of θ-Defensins against Multidrug-Resistant Candida Species

2018 ◽  
Vol 62 (6) ◽  
Author(s):  
Virginia Basso ◽  
Angie Garcia ◽  
Dat Q. Tran ◽  
Justin B. Schaal ◽  
Patti Tran ◽  
...  
Keyword(s):  
Fungal Pathogens ◽  
Atp Release ◽  
Multidrug Resistant ◽  
Human Saliva ◽  
Drug Resistant ◽  
Candida Auris ◽  
Cell Permeabilization ◽  
Content Type ◽  
Atp Production ◽  
New Therapeutic Approaches

ABSTRACT Systemic candidiasis is a growing health care concern that is becoming even more challenging due to the growing frequency of infections caused by multidrug-resistant (MDR) Candida species. Thus, there is an urgent need for new therapeutic approaches to candidiasis, including strategies bioinspired by insights into natural host defense against fungal pathogens. The antifungal properties of θ-defensins, macrocyclic peptides expressed in tissues of Old World monkeys, were investigated against a panel of drug-sensitive and drug-resistant clinical isolates of Candida albicans and non- albicans Candida species. Rhesus θ-defensin 1 (RTD-1), the prototype θ-defensin, was rapidly and potently fungicidal against drug-sensitive and MDR C. albicans strains. Fungal killing occurred by cell permeabilization that was temporally correlated with ATP release and intracellular accumulation of reactive oxygen species (ROS). Killing by RTD-1 was compared with that by histatin 5 (Hst 5), an extensively characterized anticandidal peptide expressed in human saliva. RTD-1 killed C. albicans much more rapidly and at a >200-fold lower concentration than that of Hst 5. Unlike Hst 5, the anticandidal activity of RTD-1 was independent of mitochondrial ATP production. Moreover, RTD-1 was completely resistant to Candida proteases for 2 h under conditions that rapidly and completely degraded Hst 5. MICs and minimum fungicidal concentrations (MFCs) of 14 natural θ-defensins isoforms against drug-resistant C. albicans isolates identified peptides that are more active than amphotericin B and/or caspofungin against fluconazole-resistant organisms, including MDR Candida auris. These results point to the potential of macrocyclic θ-defensins as structural templates for the design of antifungal therapeutics.

scholarly journals In Vitro Activity of Ibrexafungerp (SCY-078) against Candida auris Isolates as Determined by EUCAST Methodology and Comparison with Activity against C. albicans and C. glabrata and with the Activities of Six Comparator Agents

2019 ◽  
Vol 64 (3) ◽  
Author(s):  
Maiken Cavling Arendrup ◽  
Karin Meinike Jørgensen ◽  
Rasmus Krøger Hare ◽  
Anuradha Chowdhary
Keyword(s):  
Test Performance ◽  
Multidrug Resistant ◽  
Wild Type ◽  
Candida Auris ◽  
Robust Test ◽  
Content Type ◽  
Resistant Species ◽  
Upper Limits ◽  
Fluconazole Resistant

ABSTRACT Ibrexafungerp (SCY-078) is a novel first-in-class antifungal agent targeting glucan synthase. Candida auris is an emerging multidrug-resistant species that has caused outbreaks on five continents. We investigated the in vitro activity of ibrexafungerp against C. auris by applying EUCAST E.Def 7.3.1 methodology. C. albicans and C. glabrata, as well as anidulafungin, micafungin, amphotericin B, fluconazole, voriconazole, and isavuconazole, were included as comparators. Three C. auris reference strains (CBS12372, CBS12373, and CBS10913) and 122 C. auris, 16 C. albicans, and 16 C. glabrata isolates were evaluated. C. albicans ATCC 64548, C. parapsilosis ATCC 22019, and C. krusei ATCC 6258 served as quality control strains. Echinocandin-resistant isolates were fks sequenced. MIC ranges and modal MIC and MIC50 values were determined. Wild-type upper limits (the upper MIC value where the wild-type distribution ends) were determined according to EUCAST principles for setting ECOFFs. Nine repetitions of three QC strains and MICs for C. albicans and C. glabrata yielded narrow MIC ranges with modal MICs in agreement with established EUCAST modal MICs, confirming a robust test performance. The ibrexafungerp MICs against C. auris isolates displayed a Gaussian distribution with a modal MIC (range) of 0.5 mg/liter (0.06 to 2 mg/liter), suggesting uniform susceptibility. Of 122 isolates, 8 were echinocandin resistant and harbored the S639F Fks1 alteration. All but one were fluconazole resistant, and the MIC distributions for voriconazole and isavuconazole were multimodal confirming variable susceptibility. Ibrexafungerp demonstrated promising activity against C. auris, including isolates resistant to echinocandins and/or other agents. The MICs were similar to those reported for the Clinical and Laboratory Standards Institute method, suggesting that a common clinical breakpoint may be appropriate.

scholarly journals Advances in Phage Therapy: Targeting the Burkholderia cepacia Complex

Viruses ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1331
Author(s):  
Philip Lauman ◽  
Jonathan J. Dennis
Keyword(s):  
Burkholderia Cepacia ◽  
Bacterial Infections ◽  
Phage Therapy ◽  
Treatment Strategies ◽  
Multidrug Resistant ◽  
Modern Medicine ◽  
Burkholderia Cepacia Complex ◽  
Drug Resistant ◽  
The Past ◽  
Resistant Species

The increasing prevalence and worldwide distribution of multidrug-resistant bacterial pathogens is an imminent danger to public health and threatens virtually all aspects of modern medicine. Particularly concerning, yet insufficiently addressed, are the members of the Burkholderia cepacia complex (Bcc), a group of at least twenty opportunistic, hospital-transmitted, and notoriously drug-resistant species, which infect and cause morbidity in patients who are immunocompromised and those afflicted with chronic illnesses, including cystic fibrosis (CF) and chronic granulomatous disease (CGD). One potential solution to the antimicrobial resistance crisis is phage therapy—the use of phages for the treatment of bacterial infections. Although phage therapy has a long and somewhat checkered history, an impressive volume of modern research has been amassed in the past decades to show that when applied through specific, scientifically supported treatment strategies, phage therapy is highly efficacious and is a promising avenue against drug-resistant and difficult-to-treat pathogens, such as the Bcc. In this review, we discuss the clinical significance of the Bcc, the advantages of phage therapy, and the theoretical and clinical advancements made in phage therapy in general over the past decades, and apply these concepts specifically to the nascent, but growing and rapidly developing, field of Bcc phage therapy.

scholarly journals Thinking beyond the Common Candida Species: Need for Species-Level Identification of Candida Due to the Emergence of Multidrug-Resistant Candida auris

2017 ◽  
Vol 55 (12) ◽  
pp. 3324-3327 ◽  
Author(s):  
Shawn R. Lockhart ◽  
Brendan R. Jackson ◽  
Snigdha Vallabhaneni ◽  
Luis Ostrosky-Zeichner ◽  
Peter G. Pappas ◽  
...  
Keyword(s):  
Invasive Candidiasis ◽  
Nosocomial Infections ◽  
Multidrug Resistant ◽  
Species Level ◽  
Candida Auris ◽  
Content Type ◽  
Resistant Species ◽  
Content Identification ◽  
The Common ◽  
Level Identification

ABSTRACTCandidaspecies are one of the leading causes of nosocomial infections. Because much of the treatment forCandidainfections is empirical, some institutions do not identifyCandidato species level. With the worldwide emergence of the multidrug-resistant speciesCandida auris, identification ofCandidato species level has new clinical relevance. Species should be identified for invasive candidiasis isolates, and species-level identification can be considered for selected noninvasive isolates to improve detection ofC. auris.

scholarly journals Candida Auris, An Agent of Hospital-Associated Outbreaks: Which Challenging Issues Do We Need to Have in Mind?

2020 ◽  
Vol 8 (2) ◽  
pp. 181 ◽  
Author(s):  
Raquel Sabino ◽  
Cristina Veríssimo ◽  
Álvaro Ayres Pereira ◽  
Francisco Antunes
Keyword(s):  
Prevention And Control ◽  
Infection Prevention ◽  
Multidrug Resistant ◽  
Hospital Environment ◽  
Infection Prevention And Control ◽  
Indoor Environments ◽  
Candida Auris ◽  
Resistant Species ◽  
Recent Emergence ◽  
And Control

The emergence of Candida auris is considered as one of the most serious problems associated with nosocomial transmission and with infection control practices in hospital environment. This multidrug resistant species is rapidly spreading worldwide, with several described outbreaks. Until now, this species has been isolated from different hospital surfaces, where it can survive for long periods. There are multiple unanswered questions regarding C. auris, such as prevalence in population, environmental contamination, effectiveness of infection prevention and control, and impact on patient mortality. In order to understand how it spreads and discover possible reservoirs, it is essential to know the ecology, natural environment, and distribution of this species. It is also important to explore possible reasons to this recent emergence, namely the environmental presence of azoles or the possible effect of climate change on this sudden emergence. This review aims to discuss some of the most challenging issues that we need to have in mind in the management of C. auris and to raise the awareness to its presence in specific indoor environments as hospital settings.

Invasive Candidiasis

2020 ◽  
Vol 41 (01) ◽  
pp. 003-012 ◽  
Author(s):  
María F. Gonzalez-Lara ◽  
Luis Ostrosky-Zeichner
Keyword(s):  
Invasive Candidiasis ◽  
Antifungal Agents ◽  
Multiorgan Failure ◽  
Antifungal Susceptibility ◽  
Multidrug Resistant ◽  
Etiologic Agent ◽  
Failure Diagnosis ◽  
High Morbidity ◽  
Candida Auris ◽  
Resistant Species

AbstractInvasive candidiasis (IC) is the most frequent health care associated invasive fungal infection. It is also associated with high morbidity, mortality, and cost. The most frequent etiologic agent is Candida albicans, but non-albicans species are increasing and associated with reduced antifungal susceptibility and outbreaks. Candida auris is an emerging multidrug-resistant species recently described. IC presents as a spectrum of disease, going from fungemia to deep-seated candidiasis, and to septic shock with multiorgan failure. Diagnosis of IC is challenging. Several biomarkers and molecular methods are available for improving diagnosis. Early initial treatment with echinocandins is the treatment of choice. Step-down therapy when antifungal susceptibility is available is possible. Several new antifungal agents for the treatment of IC are in clinical development.

scholarly journals Development a hydrolysis probe-based quantitative PCR assay for the specific detection and quantification of Candida auris

2020 ◽  
Author(s):  
Hadis Jafarian ◽  
Hossein Khodadadi ◽  
Parisa Badiee
Keyword(s):  
Real Time ◽  
Multidrug Resistant ◽  
Qpcr Assay ◽  
Nuclear Ribosomal Dna ◽  
Candida Auris ◽  
Accurate Identification ◽  
Hydrolysis Probe ◽  
Standard Curve ◽  
Specific Pcr ◽  
Species Specific

Background and Purpose: Candida auris is an emerging multidrug-resistant pathogen. The identification of this species with the conventional phenotypic or biochemical mycological methods may lead to misidentification. Molecular-based species-specific identification methods such as quantitative real-time polymerase chain reaction (qPCR) facilitate a more reliable identification of C. auris than mycological methods. Regarding this, the present study aimed to develop a hydrolysis probe-based qPCR assay for the rapid, accurate identification of C. auris. Materials and Methods: The internal transcribed spacer 2 regions in the nuclear ribosomal DNA of C. auris and other related yeasts were assayed to find a specific PCR target for C. auris. A 123-base-pair target was selected, and primers and a probe were designed for hydrolysis probe-based real-time PCR with TaqMan chemistry. Ten-fold serial dilutions of C. auris ranging from 106 to 100 CFU/mL were prepared to establish a standard curve to quantify the yeast. Results: The qPCR assay was able to identify and quantify C. auris with a detection limit of 1 C. auris CFU per reaction. Specificity was confirmed by the non-amplification of the sequences belonging to other Candida species, yeasts, molds, bacteria, or human DNAs. The standard curve of the assay showed a highly significant linearity between threshold values and dilution rates (R2=0.99; slope=−3.42). Conclusion: The applied qPCR assay facilitated the rapid and accurate identification and quantification of emerging opportunistic C. auris. Therefore, considering the promising test validation results, we succeeded to develop a rapid and accurate hydrolysis probe-based qPCR assay for the screening and identification of C. auris.

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