Candida kefyr in Kuwait: Prevalence, antifungal drug susceptibility and genotypic heterogeneity

Abstract

Objective Candida kefyr causes invasive candidiasis in immunocompromised patients, particularly among those with oncohematological diseases. This study determined the prevalence of C . kefyr among yeast isolates collected during 2011–2018 in Kuwait. Antifungal susceptibility testing (AST) and genotypic heterogeneity among C . kefyr was also studied. Methods Clinical C . kefyr isolates recovered from bloodstream and other specimens during 2011 to 2018 were retrospectively analyzed. All C . kefyr isolates were identified by CHROMagar Candida, Vitek2 and PCR amplification of rDNA. AST was performed by Etest. Molecular basis of resistance to fluconazole and echinocandins was studied by PCR-sequencing of ERG11 and FKS1 , respectively. Genotypic heterogeneity was determined with microsatellite-/minisatellite-based primers and for 27 selected isolates by PCR-sequencing of IGS1 region of rDNA. Results Among 8257 yeast strains, 69 C . kefyr (including four bloodstream) isolates were detected by phenotypic and molecular methods. Isolation from urine and respiratory samples from female and male patients was significantly different ( P = 0.001). Four isolates showed reduced susceptibility to amphotericin B and one isolate to all (amphotericin B, fluconazole, voriconazole and caspofungin/micafungin) antifungals tested. Fluconazole-resistant isolate contained only synonymous mutations in ERG11 . Echinocandin-resistant isolate contained wild-type hotspot-1 and hotspot-2 of FKS1 . Fingerprinting with microsatellite-/minisatellite-based primers identified only three types. IGS1 sequencing identified seven haplotypes among 27 selected isolates. Conclusions The overall prevalence of C . kefyr among clinical yeast isolates and among candidemia cases was recorded as 0.83% and 0.32%, respectively. The frequency of isolation of C . kefyr from bloodstream and other invasive samples was stable during the study period. The C . kefyr isolates grown from invasive (bloodstream, bronchoalveolar lavage, abdominal drain fluid, peritonial fluid and gastric fluid) samples and amphotericin B-resistant isolates were genotypically heterogeneous strains.

Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal Susceptibility, and Infection Control Measures to Combat the Spread of Infections in Healthcare Facilities

“…This has resulted in the selection of Candida spp. with reduced susceptibility to antifungal drugs, and infections are now associated with higher mortality rates as they often lead to adverse clinical outcomes [ 19 , 21 , 22 , 23 , 24 , 25 ]. In recent years, we have witnessed an increasing number of reports describing invasive infections by multidrug-resistant Candida spp.…”

Molecular characterisation of Candida auris isolates from immunocompromised patients in a tertiary‐care hospital in Kuwait reveals a novel mutation in FKS1 conferring reduced susceptibility to echinocandins

“…as well as infections with drugresistant strains have increased considerably in select patient populations in recent years. 6,16,[26][27][28][29][30][31][32] Candida auris is a recently described yeast species which has now emerged as an important nosocomial pathogen causing invasive infections and outbreaks in more than 47 countries worldwide. [33][34][35] C auris readily colonises human skin and is shed into the environment that facilitates its transmission to other hospitalised patients, particularly in ICU settings.…”

Epidemiology of Candidemia in Kuwait: A Nationwide, Population-Based Study

“…However, the past two decades have seen a gradual change in the spectrum of species causing candidemia, so much so that >50% of candidemia cases are now caused by non- albicans Candida species, which mainly include C. glabrata complex members, C. parapsilosis complex members, and C. tropicalis as well as many emerging pathogens, likely as a result of the increasing use of fluconazole or other antifungal drugs for prophylaxis or therapy [ 6 , 14 , 17 , 18 ]. Candida non- albicans species are associated with even higher rates of mortality and a higher frequency of resistance to antifungal drugs than what is seen with C. albicans infections [ 6 , 7 , 14 , 19 , 20 , 21 ]. More recently, the emergence and rapid spreading of the often multidrug-resistant Candida auris has dramatically changed the epidemiology of candidemia at many geographical locations/health care facilities as it has become the most common or one of the more common causes of invasive Candida infections [ 22 ].…”