Drug Resistance-Associated Mutations in <i>ERG11</i> of Multidrug-Resistant <i>Candida auris</i> in a Tertiary Care Hospital of Eastern Saudi Arabia

• Main Authors: Reem AlJindan, Doaa M. AlEraky, Nehal Mahmoud, Baha Abdalhamid, Mashael Almustafa, Sayed AbdulAzeez, J. Francis Borgio
• Format: Article
• Language: English
• Published: MDPI AG 2021-12-01
• Series: Journal of Fungi
• Subjects: <i>Candida auris</i>; nosocomial infections; emerging pathogen; resistance genes; Saudi Arabia
• Online Access: https://www.mdpi.com/2309-608X/7/1/18

<i>Candida auris</i> is an emerging multi-drug resistant pathogen with high mortality rate; nosocomial infections have been reported worldwide, causing a major challenge for clinicians and microbiological laboratories. The study aims to describe new cases of <i>C. auris</i> and detect drug resistance-associated mutations of <i>C. auris</i> by the sequencing of <i>ERG11</i> and <i>FKS1</i> genes. A total of six specimens were collected from blood, urine, ear swab, and groin screening samples. Isolates were incubated for 48 h on Sabouraud Dextrose agar (SDA) at 42 °C, then confirmed by MALDI-TOF MS. Furthermore, antifungal susceptibility testing was performed using the Vitek 2 system to detect Minimum Inhibitory Concentrations (MICs) of six antifungals. Sequences of <i>18S rRNA</i> gene and ITS regions from isolates and phylogenetic analysis were performed. Gene sequencing was analysed to detect drug resistance-associated mutations by <i>FKS1</i> and <i>ERG11</i> genes sequencing. All <i>C. auris</i> isolates were confirmed by MALDI-TOF MS, and evolutionary analyses using sequences of <i>18S rRNA</i> gene and ITS region. Antifungal susceptibility testing showed that all isolates were resistant to fluconazole. Sequencing of <i>ERG11</i> and <i>FKS1</i> genes from the isolates revealed the presence of two (F132Y and K143R) drug resistance-associated mutations in <i>ERG11</i>, however, <i>FKS1</i> gene was devoid of mutations. The study sheds light on a public health threat of an emerging pathogen, and the hospital implemented strict contact screening and infection control precautions to prevent <i>C. auris</i> infection. Finally, there is a critical need to monitor the antifungal resistance in different geographical areas and implementation of efficient guidelines for treatment.