Candida auris in Austria—What Is New and What Is Different

Abstract

Candida auris is a novel and emerging pathogenic yeast which represents a serious global health threat. Since its first description in Japan 2009, it has been associated with large hospital outbreaks all over the world and is often resistant to more than one antifungal drug class. To date, five C. auris isolates have been detected in Austria. Morphological characterization and antifungal susceptibility profiles against echinocandins, azoles, polyenes and pyrimidines, as well as the new antifungals ibrexafungerp and manogepix, were determined. In order to assess pathogenicity of these isolates, an infection model in Galleria mellonella was performed and whole genome sequencing (WGS) analysis was conducted to determine the phylogeographic origin. We could characterize four isolates as South Asian clade I and one isolate as African clade III. All of them had elevated minimal inhibitory concentrations to at least two different antifungal classes. The new antifungal manogepix showed high in vitro efficacy against all five C. auris isolates. One isolate, belonging to the African clade III, showed an aggregating phenotype, while the other isolates belonging to South Asian clade I were non-aggregating. In the Galleria mellonella infection model, the isolate belonging to African clade III exhibited the lowest in vivo pathogenicity. As the occurrence of C. auris increases globally, it is important to raise awareness to prevent transmission and hospital outbreaks.

The Austrian landscape of diagnostic capacity and access to treatment for invasive fungal infections

“…In the case of moulds, three of the laboratories can identify cryptic species. This, together with full access to antifungal susceptibility testing, facilitates the correct and timely diagnosis of invasive fungal infections, allowing the administration of targeted antifungal treatment and the identification of specific needs in the case of a patient infected by a multidrug resistant pathogen, as previously described in the country 12 …”

“…This, together with full access to antifungal susceptibility testing, facilitates the correct and timely diagnosis of invasive fungal infections, allowing the administration of targeted antifungal treatment and the identification of specific needs in the case of a patient infected by a multidrug resistant pathogen, as previously described in the country. 12 General access to all antifungals described as first-line treatment for the most common invasive fungal infections is ensured in Austria, following recommendations of the WHO and the global guidelines programme. [18][19][20][21][22][23][24][25][26][27][28][29]31 In this work, we had to face some limitations.…”

“…Moreover, the incidence of multidrug resistant moulds and yeasts has also been depicted in the country. Despite azole‐resistance has still been described as low, 9–11 as of March 2022, five cases of Candida auris infections have already been reported 12 …”

“…Despite azole-resistance has still been described as low, [9][10][11] as of March 2022, five cases of Candida auris infections have already been reported. 12 Here, we aim to describe the current landscape of laboratory diagnosis and treatment capacity of invasive fungal infections in Austria. This will allow us to highlight the potential weaknesses of Austrian institutions and provide guidance to policymakers and medical teams to improve the situation where necessary.…”

Genotypic and phenotypic characterization of a nosocomial outbreak ofCandida aurisin Spain during five years

“…Interestingly, a case from Austria (strain “Cau4”) was found to be closely related to the Spanish isolates. Using public epidemiological information on the isolate, we realized that the patient had been admitted to a hospital in Valencia during October 2021, suggesting that the infection occurred during his time in the facility (23). The maximum distance between Spanish and other clade III isolates was 60 SNPs, being in line with the mean number of SNPs within each cluster, as reported previously (<70 SNPs) (4).…”