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Multiple introductions and subsequent transmission of multidrug-resistant Candida auris in the USA: a molecular epidemiological survey.
Open accessAbstract
Background Transmission of multidrug-resistant Candida auris infection has been reported in the USA. To better understand its emergence and transmission dynamics and to guide clinical and public health responses, we did a molecular epidemiological investigation of C auris cases in the USA.Methods In this molecular epidemiological survey, we used whole-genome sequencing to assess the genetic similarity between isolates collected from patients in ten US states (California, Connecticut, Florida, Illinois, Indiana, Maryland, Massachusetts, New Jersey, New York, and Oklahoma) and those identified in several other countries (Colombia, India, Japan, Pakistan, South Africa, South Korea, and Venezuela). We worked with state health departments, who provided us with isolates for sequencing. These isolates of C auris were collected during the normal course of clinical care (clinical cases) or as part of contact investigations or point prevalence surveys (screening cases). We integrated data from standardised case report forms and contact investigations, including travel history and epidemiological links (ie, patients that had shared a room or ward with a patient with C auris). Genetic diversity of C auris within a patient, a facility, and a state were evaluated by pairwise differences in single-nucleotide polymorphisms (SNPs).Findings From May 11, 2013, to Aug 31, 2017, isolates that corresponded to 133 cases (73 clinical cases and 60 screening cases) were collected. Of 73 clinical cases, 66 (90%) cases involved isolates related to south Asian isolates, five (7%) cases were related to South American isolates, one (1%) case to African isolates, and one (1%) case to east Asian isolates. Most (60 [82%]) clinical cases were identified in New York and New Jersey; these isolates, although related to south Asian isolates, were genetically distinct. Genomic data corroborated five (7%) clinical cases in which patients probably acquired C auris through health-care exposures abroad. Among clinical and screening cases, the genetic diversity of C auris isolates within a person was similar to that within a facility during an outbreak (median SNP difference three SNPs, range 0-12).Interpretation Isolates of C auris in the USA were genetically related to those from four global regions, suggesting that C auris was introduced into the USA several times. The five travel-related cases are examples of how introductions can occur. Genetic diversity among isolates from the same patients, health-care facilities, and states indicates that there is local and ongoing transmission.Funding US Centers for Disease Control and Prevention.
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“The clades differ by tens to hundreds of thousands of DNA base pairs, but isolates are highly clonal within each clade (Chow et al., 2018).”
From Murine model of colonization with fungal pathogen Candida auris to explore skin tropism, host risk factors and therapeutic strategies (2021) · cites this paper as Chow et al., 2018
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“ongoing transmission of C. auris has been detected in several areas in the United States, primarily in Illinois, New Jersey, and New York (66)”
From Population-Based Active Surveillance for Culture-Confirmed Candidemia — Four Sites, United States, 2012–2016 (2019) · cites this paper as [66]
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Metadata
- Authors
- Chow, N. A., Gade, L., Tsay, S. V., Forsberg, K., Greenko, J. A., Southwick, K. L., Barrett, P. M., Kerins, J. L., Lockhart, S. R., Chiller, T. M., Litvintseva, A. P., Adams, E., Barton, K., Beer, K. D., Bentz, M. L., Berkow, E. L., Black, S., Bradley, K. K., Brooks, R., Chaturvedi, S., Clegg, W., Cumming, M., DeMaria, A., Dotson, N., Epson, E., Fernandez, R., Fulton, T., Greeley, R., Jackson, B., Kallen, A., Kemble, S., Klevens, M., Kuykendall, R., Le, N. H., Leung, V., Lutterloh, E., Mcateer, J., Pacilli, M., Peterson, J., Quinn, M., Ross, K., Rozwadowski, F., Shannon, D., Skrobarcek, K. A., Vallabhaneni, S., Welsh, R., & Zhu, Y.
- Affiliations
- Centers for Disease Control and Prevention (US)
- New York State Department of Health (US)
- New Jersey Department of Health (US)
- Chicago Department of Public Health (US)
- Corresponding author
- Chow, Nancy A
- ORCID
- Chow, Nancy A
- Gade, Lalitha
- Tsay, Sharon V
- Forsberg, Kaitlin
- Greenko, Jane A
- Southwick, Karen L
- Kerins, Janna L
- Lockhart, Shawn R
- Chiller, Tom M
- Litvintseva, Anastasia P
- Bentz, Meghan L
- Berkow, Elizabeth L
- Black, Stephanie
- Brooks, Richard
- Chaturvedi, Sudha
- Cumming, Melissa
- DeMaria, Alfred
- Epson, Erin
- Jackson, Brendan
- Kallen, Alexander
- Kemble, Sarah
- Leung, Vivian
- Pacilli, Massimo
- Ross, Kathleen
- Rozwadowski, Faye
- Skrobarcek, Kimberly A
- Vallabhaneni, Snigdha
- Welsh, Rory
- Zhu, Yan
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 18
- Issue
- 12
- Pages
- 1377-1384
- ISSN
- 1473-3099 (ISSN-L)
- PMC
- PMC6556114
- OpenAlex
- W2894978041
- Cited by
- 289
- References
- 19
- Citations by year
- 2026: 14 · 2025: 28 · 2024: 43 · 2023: 40 · 2022: 37 · 2021: 47 · 2020: 34 · 2019: 40 · 2018: 6
- FWCI
- 24.02
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (CC999999)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Immunology and Microbiology › Microbiology › Yeasts and Rust Fungi Studies
- Health Sciences › Medicine › Infectious Diseases › Fungal Infections and Studies
- Keywords
- Candida auris, multidrug resistance, fungal transmission, molecular epidemiology, whole genome sequencing, single nucleotide polymorphisms, genetic diversity, travel-associated infection, hospital outbreak, contact investigation, United States, South Asia, New York, New Jersey, outbreak investigation, infection control, travel medicine
- MeSH terms
- Whole Genome Sequencing, Communicable Diseases, Imported, Adult, Aged, Aged, 80 and over, Candida, Candidiasis, Female, Genotype, Humans, Male, Middle Aged, Prospective Studies, Travel, United States, Prevalence, Molecular Epidemiology, Disease Transmission, Infectious, Drug Resistance, Multiple, Fungal, Young Adult
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