Identification and Antifungal Drug Susceptibility Pattern of Candida auris in India

Smita Deshkar; Niranjan Patil; Shraddha Amberkar; Ashish Lad; Farozan Siddiqui; Swati Sharan

doi:10.4103/jgid.jgid_44_22

Identification and Antifungal Drug Susceptibility Pattern of Candida auris in India

J Glob Infect Dis. 2022 Nov 1;14(4):131-135. doi: 10.4103/jgid.jgid_44_22. eCollection 2022 Oct-Dec.

Authors

Smita Deshkar¹, Niranjan Patil¹, Shraddha Amberkar¹, Ashish Lad¹, Farozan Siddiqui², Swati Sharan³

Affiliations

¹ Department of Infectious Diseases, Metropolis Healthcare Limited, Global Reference Laboratory, Mumbai, Maharashtra, India.
² Department of Microbiology, Metropolis Healthcare Limited, Global Reference Laboratory, Mumbai, Maharashtra, India.
³ Department of Molecular Biology, Metropolis Healthcare Limited, Global Reference Laboratory, Mumbai, Maharashtra, India.

Abstract

Introduction: Candida auris has turned up as a multidrug-resistant nosocomial agent with outbreaks reported worldwide. The present study was conducted to evaluate the antifungal drug susceptibility pattern of C. auris.

Methods: Isolates of C. auris were obtained from clinically suspected cases of candidemia from January 2019 to June 2021. Identification was done with matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) and panfungal DNA polymerase chain reaction (PCR), followed by sequencing. Antifungal susceptibility testing was performed with broth microdilution method.

Results: Out of 50 isolates C. auris, 49 were identified by MALDI-TOF and one isolate was identified with panfungal DNA PCR followed by sequencing. For fluconazole, 84% (n = 42) isolates were found to be resistant and 16% (n = 8) isolates were susceptible (minimum inhibitory concentrations [MICs] range 0.5-16). Posaconazole exhibited potent activity, followed by itraconazole. For amphotericin B, only 6% (n = 3) isolates were resistant with MICs ≥2 μg/mL. Only 4% (n = 2) isolates exhibited resistance to caspofungin. No resistance was noted for micafungin and anidulafungin. One (2%) isolate was found to be panazole resistant. One (2%) isolate was resistant to fluconazole, amphotericin B, and caspofungin.

Conclusion: Correct identification of C. auris can be obtained with the use of MALDI-TOF and sequencing methods. A small percentage of fluconazole-sensitive isolates are present. Although elevated MICs for amphotericin B and echinocandins are not generally observed, the possibility of resistance with the irrational use of these antifungal drugs cannot be denied. Pan azole-resistant and pan drug-resistant strains of C. auris are on rise.

Keywords: Antifungal drug susceptibility; Candida auris; broth microdilution; identification; matrix-assisted laser desorption/ionization-time of flight; panfungal polymerase chain reaction.