Researchers find C.auris strains immune to all meds; doctors urge need for new antibiotics to fight it
Since a global alert on pathogenic fungus Candida auris in 2009, Indian scientists have been actively engaged in research on the strains of this fungi. A recent report of the study indicates that the strains found in Indian hospitals are multi-drug resistant.
The Council of Scientific and Industrial Research–Institute of Genomics and Integrative Biology (CSIR-IGIB), New Delhi, and Department of Medical Mycology, Vallabhbhai Patel Chest Institute, Delhi University, conducted a full genome sequencing on six strains of Candida auris, and have published their findings in the latest issue of the UK journal Elsevier.
“A full genome sequencing analysis of Candida Auris isolates from four Indian hospitals — three in Delhi and one in Kochi — revealed a clonal transmission, that is the same strains were circulating in Indian hospitals. All C. auris isolates analysed originated from cases of fungaemia (fatal fungal infection, a form of sepsis) and were resistant to fluconazole (a broad-spectrum antifungal medication),” said Dr Anuradha Choudhary, Associate Professor and Head, Department of Medical Mycology, Vallabhbhai Patel Chest Institute.
“This emerging multi-drug resistant yeast causes acute hospital-acquired infections. The emergence of this yeast is alarming doctors, as it also exhibits resistance to azoles, amphotericin B and caspofungin, all anti-fungal drugs,” she said.
Molecular identification are not part of routine testing in diagnostic laboratories, and C. auris can only be identified by genome sequencing. Doctors insist that due to this, fungaemia is likely to be much more prevalent than reports indicate. As per IGIB and Delhi’s Chest Institute reports, about 40 cases have been documents until 2015.
C. auris infection has been reported to occur in all age groups, and bloodstream infections have a 60 per cent mortality rate.
Hospitalised patients are at high risk. “Recent surgery, diabetes, broad-spectrum antibiotic and anti-fungal drugs, and central venous catheter use are all risk factors,” said Dr Anoop Misra, Chairman, Fortis-C-DOC, Centre for Diabetes, Metabolic Diseases and Endocrinology.
“Fungus infections, especially multiple drug-resistant ones, are difficult to treat and C. auris in particular carries a high mortality rate. With prevalence of suppressed immune response among patients, including those with uncontrolled diabetes, this is a big concern. Early diagnosis and treatment is crucial,” said Dr Misra.
As part of standard procedure, ICMR is already looking into this. Director General, ICMR and Secretary, Department of Health Research, Ministry of Health and Family Welfare, Dr Soumya Swaminathan, said, “We have a network of tertiary hospitals looking at fungal infections and their drug resistance. We are also looking at how common Candida auris is.”
Frequent use of antibiotics or anti-fungals is supposed to be a cause of origin for any multi-drug resistant fungi. Doctors have urged for the need for new antibiotics.
At least a dozen countries have reported drug-resistant Candida Auris, in the last five years. C. auris was first reported in 2009 after being isolated from the external ear canal discharge of a patient in Japan. In the same year, about 15 isolates of C. auris were reported in South Korea.
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