A multicentre study of antifungal susceptibility patterns among 350 Candida auris isolates (2009–17) in India: role of the ERG11 and FKS1 genes in azole and echinocandin resistance
Open accessAbstract
Background: Candida auris has emerged globally as an MDR nosocomial pathogen in ICU patients. Objectives: We studied the antifungal susceptibility of C. auris isolates (n = 350) from 10 hospitals in India collected over a period of 8 years. To investigate azole resistance, ERG11 gene sequencing and expression profiling was conducted. In addition, echinocandin resistance linked to mutations in the C. auris FKS1 gene was analysed. Methods: CLSI antifungal susceptibility testing of six azoles, amphotericin B, three echinocandins, terbinafine, 5-flucytosine and nystatin was conducted. Screening for amino acid substitutions in ERG11 and FKS1 was performed. Results: Overall, 90% of C. auris were fluconazole resistant (MICs 32 to ≥64 mg/L) and 2% and 8% were resistant to echinocandins (≥8 mg/L) and amphotericin B (≥2 mg/L), respectively. ERG11 sequences of C. auris exhibited amino acid substitutions Y132 and K143 in 77% (n = 34/44) of strains that were fluconazole resistant whereas WT genotypes, i.e. without substitutions at these positions, were observed in isolates with low fluconazole MICs (1-2 mg/L) suggesting that these substitutions confer a phenotype of resistance to fluconazole similar to that described for Candida albicans. No significant expression of ERG11 was observed, although expression was inducible in vitro with fluconazole exposure. Echinocandin resistance was linked to a novel mutation S639F in FKS1 hot spot region I. Conclusions: Overall, 25% and 13% of isolates were MDR and multi-azole resistant, respectively. The most common resistance combination was azoles and 5-flucytosine in 14% followed by azoles and amphotericin B in 7% and azoles and echinocandins in 2% of isolates.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Resistance to all three classes of antifungals in C. auris is reported most commonly in India in South Asia (3%), whereas this is much less common in other regions of the world.
“Resistance to all three classes of antifungals is reported most commonly in India in South Asia (3%), whereas this is much less common in other regions of the world.122–124”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [124]
The JAC section reports that 2% of the Indian isolates had combined azole and echinocandin resistance. Resistance to all three classes could not therefore occur in 3% of those isolates. The Discussion’s 3% figure refers to echinocandin resistance alone among US isolates, and the paper does not establish that triple-class resistance is most common in India. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn Candida auris, ERG11 polymorphisms and extra ERG11 gene copies are thought to underlie its mostly intrinsic azole resistance.
“Finally, in Candida auris, ERG11 polymorphisms as well as an increased number of ERG11 gene copies are thought to be responsible for its largely intrinsic azole resistance37–40”
From Drug resistance and tolerance in fungi. (2020) · cites this paper as [40]
The Discussion (page unavailable) links ERG11 substitutions Y132F and K143R to fluconazole resistance in the C. auris isolates studied. It does not establish that C. auris has extra ERG11 gene copies or that its azole resistance is largely intrinsic. The reported increase after fluconazole exposure concerns ERG11 expression, not gene copy number. (LLM, conf=0.88)
Experimental — accuracy not yet measuredC. auris clades display substantial genetic diversity and distinct phenotypic traits, especially diminished susceptibilities to antifungal therapies.
“Furthermore, C. auris clades display substantial genetic diversity and show distinct phenotypic traits, especially diminished susceptibilities to antifungal therapies (11–14).”
From Transcriptomics and Phenotyping Define Genetic Signatures Associated with Echinocandin Resistance in Candida auris (2022) · cites this paper as [12]
The Introduction (page unavailable) reports ERG11 alterations associated with geographic clades and describes high fluconazole MICs and variable susceptibility to other antifungals. The paper also reports resistance among its Indian isolates, but it does not establish substantial genetic diversity across clades or show that clades as a whole have distinct phenotypic traits. (LLM, conf=0.83)
Experimental — accuracy not yet measuredResistance to the echinocandins (up to 7%) and amphotericin B (up to 35%) in C. auris varies greatly between geographic regions.
“Resistance to the echinocandins (up to 7%) and amphotericin B (up to 35%) vary greatly between geographic regions.122–124”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [124]
The Introduction reports 7% echinocandin resistance and 35% amphotericin B resistance in a four-country sample, and the Discussion describes geographic differences. But those percentages are pooled results, not regional upper limits: the Discussion reports 43% amphotericin B resistance among US isolates and 5 of 6 isolates in Israel. (LLM, conf=0.88)
Experimental — accuracy not yet measuredC. auris can show clinical resistance to all classes of antifungal drugs, including echinocandins.
“C. auris can show clinical resistance to all classes of antifungal drugs, including echinocandins that are usually recommended as first-line therapies for invasive candidiasis.”
From Transcriptomics and Phenotyping Define Genetic Signatures Associated with Echinocandin Resistance in Candida auris (2022) · cites this paper as [12]
Table 4 reports a C. auris isolate with resistance to azoles, amphotericin B and echinocandins, supporting the possibility of resistance across these drug classes. However, the study measured in vitro susceptibility, and the Discussion says species-specific clinical breakpoints had not been established; it does not establish clinical resistance or treatment failure. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Resistance to FCZ or AmB is frequently observed among clade I isolates.
“While resistance to FCZ or AmB is frequently observed among clade I isolates, the frequency of ECN resistance remains low at the moment (11, 12, 35).”
From Transcriptomics and Phenotyping Define Genetic Signatures Associated with Echinocandin Resistance in Candida auris (2022) · cites this paper as [12]
The In vitro susceptibility testing analysis reports fluconazole MICs of 32–64 mg/L in 90% of the 350 Indian isolates, and the Discussion reports low echinocandin resistance. But the Discussion puts amphotericin B resistance at only 8%, and the paper does not identify its 350 isolates as clade I. It therefore supports the fluconazole and echinocandin pattern for the Indian isolates, not the full clade-specific claim about frequent amphotericin B resistance. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe frequency of ECN resistance remains low at the moment.
“While resistance to FCZ or AmB is frequently observed among clade I isolates, the frequency of ECN resistance remains low at the moment (11, 12, 35).”
From Transcriptomics and Phenotyping Define Genetic Signatures Associated with Echinocandin Resistance in Candida auris (2022) · cites this paper as [12]
Mutations in ERG11 contribute to reduced azole susceptibility in C. auris.
“Mutations in ERG11 also contribute to reduced azole susceptibility in the emerging fungal pathogen C. auris12–15, with a recent study highlighting a previously unreported substitution in Erg11 (F444L) identified in azole-resistant clade IV clinical isolates that has not been previously described in other reports15.”
From Molecular mechanisms governing antifungal drug resistance (2023) · cites this paper as [12]
Several amino acid substitutions in FKS1 have been associated with decreased echinocandin susceptibility in C. auris.
“Several amino acid substitutions in FKS1 have also been associated with decreased echinocandin susceptibility in C. auris12,37–42.”
From Molecular mechanisms governing antifungal drug resistance (2023) · cites this paper as [12]
There are yet-to-be-identified mechanisms of fluconazole resistance in Candida auris.
“suggesting the presence of yet-to-be-identified mechanisms of fluconazole resistance (8, 14).”
From Mutations in <i>TAC1B</i> : a Novel Genetic Determinant of Clinical Fluconazole Resistance in Candida auris (2020) · cites this paper as [8]
Clinical isolates harboring the same ERG11 mutations and exhibiting a fluconazole MIC as low as 1 mg/liter have been described.
“clinical isolates harboring the same ERG11 mutations and exhibiting a fluconazole MIC as low as 1 mg/liter have been described previously”
From Mutations in <i>TAC1B</i> : a Novel Genetic Determinant of Clinical Fluconazole Resistance in Candida auris (2020) · cites this paper as [8]
Fluconazole-resistant Candida auris isolates with no mutation in ERG11 have been described.
“as have fluconazole-resistant isolates of C. auris with no mutation in ERG11”
From Mutations in <i>TAC1B</i> : a Novel Genetic Determinant of Clinical Fluconazole Resistance in Candida auris (2020) · cites this paper as [8]
A minor but growing resistance (1-7%) has been reported towards echinocandins in Candida auris.
“However, a minor but alarmingly growing resistance (1-7%) has been reported towards the third class (echinocandins) [10,11].”
From Lansoprazole interferes with fungal respiration and acts synergistically with amphotericin B against multidrug-resistant <i>Candida auris</i> (2024) · cites this paper as [11]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Lockhart, S. R., Etienne, K. A., Vallabhaneni, S., Farooqi, J., Chowdhary, A., Govender, N. P., Colombo, A. L., Calvo, B., Cuomo, C. A., Desjardins, C. A., et al. (2017) · Clinical Infectious Diseases · doi:10.1093/cid/ciw691 · Cited by 1,662 · see citing works
Self-citationSatoh, K., Makimura, K., Hasumi, Y., Nishiyama, Y., Uchida, K., & Yamaguchi, H. (2009) · Microbiology and Immunology · doi:10.1111/j.1348-0421.2008.00083.x · Cited by 1,381 · see citing works
First hospital outbreak of the globally emerging Candida auris in a European hospital
Schelenz, S., Hagen, F., Rhodes, J. L., Abdolrasouli, A., Chowdhary, A., Hall, A., Ryan, L., Shackleton, J., Trimlett, R., Meis, J. F., et al. (2016) · Antimicrobial Resistance & Infection Control · doi:10.1186/s13756-016-0132-5 · Cited by 768 · see citing works
Self-citationChowdhary, A., Sharma, C., & Meis, J. F. (2017) · PLOS Pathogens · doi:10.1371/journal.ppat.1006290 · Cited by 750 · see citing works
Self-citationKathuria, S., Singh, P. K., Sharma, C., Prakash, A., Masih, A., Kumar, A., Meis, J. F. G. M., & Chowdhary, A. (2015) · Journal of Clinical Microbiology · doi:10.1128/jcm.00367-15 · Cited by 536 · see citing works
Self-citationFirst Three Reported Cases of Nosocomial Fungemia Caused by Candida auris
Lee, W. G., Shin, J. H., Uh, Y., Kang, M. G., Kim, S. H., Park, K. H., & Jang, H. (2011) · Journal of Clinical Microbiology · doi:10.1128/jcm.00319-11 · Cited by 524 · see citing works
Perea, S., López-Ribot, J. L., Kirkpatrick, W. R., McAtee, R. K., Santillán, R. A., Martı́nez, M., Calabrese, D., Sanglard, D., & Patterson, T. F. (2001) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.45.10.2676-2684.2001 · Cited by 470 · see citing works
Resistance Mechanisms in Clinical Isolates of <i>Candida albicans</i>
White, T. C., Holleman, S., Dy, F., Mirels, L. F., & Stevens, D. A. (2002) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.46.6.1704-1713.2002 · Cited by 461 · see citing works
Calvo, B., Melo, A. S. D. A., Mena, A. J. P., Hernandez, M., Francisco, E. C., Hagen, F., Meis, J. F. G. M., & Colombo, A. L. (2016) · Journal of Infection · doi:10.1016/j.jinf.2016.07.008 · Cited by 450 · see citing works
Self-citationNew Clonal Strain ofCandida auris, Delhi, India
Chowdhary, A., Sharma, C., Duggal, S., Agarwal, K., Prakash, A., Singh, P. K., Jain, S., Kathuria, S., Randhawa, H. S., Hagen, F., et al. (2013) · Emerging infectious diseases · doi:10.3201/eid1910.130393 · Cited by 418 · see citing works
Self-citationLarkin, E., Hager, C., Chandra, J., Mukherjee, P. K., Retuerto, M., Salem, I., Long, L., Isham, N., Kovanda, L., Borroto-Esoda, K., et al. (2017) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.02396-16 · Cited by 395 · see citing works
Multidrug-resistant endemic clonal strain of Candida auris in India
Chowdhary, A., Anil Kumar, V., Sharma, C., Prakash, A., Agarwal, K., Babu, R., Dinesh, K. R., Karim, S., Singh, S. K., Hagen, F., et al. (2014) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-013-2027-1 · Cited by 373 · see citing works
Self-citationCleveland, A. A., Farley, M. M., Harrison, L. H., Stein, B., Hollick, R., Lockhart, S. R., Magill, S. S., Derado, G., Park, B. J., & Chiller, T. M. (2012) · Clinical Infectious Diseases · doi:10.1093/cid/cis697 · Cited by 366 · see citing works
Candida auris candidaemia in Indian ICUs: analysis of risk factors
Rudramurthy, S. M., Chakrabarti, A., Paul, R. A., Sood, P., Kaur, H., Capoor, M. R., Kindo, A. J., Marak, R. S. K., Arora, A., Sardana, R., et al. (2017) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkx034 · Cited by 357 · see citing works
Self-citationBorman, A. M., Szekely, A., & Johnson, E. M. (2016) · mSphere · doi:10.1128/msphere.00189-16 · Cited by 333 · see citing works
Kim, M., Shin, J. H., Sung, H., Lee, K., Kim, E.-C., Ryoo, N. H., Lee, J., Jung, S., Park, K. H., Kee, S., et al. (2009) · Clinical Infectious Diseases · doi:10.1086/597108 · Cited by 310 · see citing works
Vallabhaneni, S., Kallen, A., Tsay, S., Chow, N., Welsh, R., Kerins, J., Kemble, S. K., Pacilli, M., Black, S. R., Landon, E., et al. (2016) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6544e1 · Cited by 302 · see citing works
Multidrug-Resistant <i>Candida haemulonii</i> and <i>C. auris</i> , Tel Aviv, Israel
Ben-Ami, R., Berman, J., Novikov, A., Bash, E., Shachor-Meyouhas, Y., Zakin, S., Maor, Y., Tarabia, J., Schechner, V., Adler, A., et al. (2017) · Emerging Infectious Diseases · doi:10.3201/eid2302.161486 · Cited by 297 · see citing works
Contribution of Clinically Derived Mutations in <i>ERG11</i> to Azole Resistance in Candida albicans
Flowers, S. A., Colón, B., Whaley, S. G., Schuler, M. A., & Rogers, P. D. (2015) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.03470-14 · Cited by 294 · see citing works
Morio, F., Loge, C., Besse, B., Hennequin, C., & Le Pape, P. (2010) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/j.diagmicrobio.2009.11.006 · Cited by 279 · see citing works
Arendrup, M. C., Prakash, A., Meletiadis, J., Sharma, C., & Chowdhary, A. (2017) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00485-17 · Cited by 270 · see citing works
Self-citation<i>Candida auris</i>–Associated Candidemia, South Africa
Magobo, R. E., Corcoran, C., Seetharam, S., & Govender, N. P. (2014) · Emerging Infectious Diseases · doi:10.3201/eid2007.131765 · Cited by 259 · see citing works
Draft genome of a commonly misdiagnosed multidrug resistant pathogen Candida auris
Chatterjee, S., Alampalli, S. V., Nageshan, R. K., Chettiar, S. T., Joshi, S., & Tatu, U. S. (2015) · BMC Genomics · doi:10.1186/s12864-015-1863-z · Cited by 247 · see citing works
Invasive Infections with Multidrug-Resistant Yeast Candida auris , Colombia
Morales-López, S. E., Parra‐Giraldo, C. M., Ceballos-Garzón, A., Martínez, H. P., Rodríguez, G. J., Álvarez, C., & Rodríguez, J. Y. (2016) · Emerging infectious diseases · doi:10.3201/eid2301.161497 · Cited by 244 · see citing works
Can Multidrug-Resistant Candidaauris Be Reliably Identified in Clinical Microbiology Laboratories?
Mizusawa, M., Miller, H., Green, R., Lee, R. E., Jr., Durante, M., Perkins, R., Hewitt, C. M., Simner, P. J., Carroll, K. C., Hayden, R. T., et al. (2016) · Journal of Clinical Microbiology · doi:10.1128/jcm.02202-16 · Cited by 218 · see citing works
Henry, K. W., Nickels, J. T., & Edlind, T. D. (2000) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.44.10.2693-2700.2000 · Cited by 216 · see citing works
Sharma, C., Kumar, N., Pandey, R., Meis, J. F., & Chowdhary, A. (2016) · New Microbes and New Infections · doi:10.1016/j.nmni.2016.07.003 · Cited by 202 · see citing works
Self-citationCandida aurisCandidemia in Kuwait, 2014
Emara, M., Ahmad, S., Khan, Z., Joseph, L., Al-Obaid, I., Purohit, P., & Bafna, R. (2015) · Emerging infectious diseases · doi:10.3201/eid2106.150270 · Cited by 185 · see citing works
Prakash, A., Sharma, C., Singh, A. K., Singh, P. K., Kumar, A., Hagen, F., Govender, N. P., Colombo, A. L., Meis, J. F. G. M., & Chowdhary, A. (2015) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2015.10.022 · Cited by 167 · see citing works
Self-citationTsay, S. V., Welsh, R. M., Adams, E. H., Chow, N. A., Gade, L., Berkow, E. L., Poirot, E., Lutterloh, E. C., Quinn, M., Chaturvedi, S., et al. (2017) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6619a7 · Cited by 160 · see citing works
Nosocomial fungemia by Candida auris: First four reported cases in continental Europe
Gaitán, A. C. R., Moret, A. M., Hontangas, J. L. L., Molina, J. M. R., López, A., Hernández-Cabezas, A., Maseres, J. B. M., Chouman-Arcas, R., Ruiz, M. D. G., Chiveli, M.-A., et al. (2017) · Revista Iberoamericana de Micología · doi:10.1016/j.riam.2016.11.002 · Cited by 158 · see citing works
Croxtall, J. D., & Plosker, G. L. (2009) · Drugs · doi:10.2165/00003495-200969030-00009 · Cited by 131 · see citing works
Pharmacodynamic Optimization for Treatment of Invasive Candida auris Infection
Lepak, A. J., Zhao, M., Berkow, E. L., Lockhart, S. R., & Andes, D. R. (2017) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00791-17 · Cited by 92 · see citing works
Araúz, A. B., Caceres, D. H., Santiago, E., Armstrong, P. A., Arosemena, S. R., Ramos, C., Espinosa-Bode, A., Borace, J., Hayer, L., Cedeño, I., et al. (2017) · Mycoses · doi:10.1111/myc.12709 · Cited by 91 · see citing works
Al-Siyabi, T., Busaidi, I. A., Balkhair, A., Muharrmi, Z. A., Al-Salti, M., & Adawi, B. A. (2017) · Journal of Infection · doi:10.1016/j.jinf.2017.05.016 · Cited by 88 · see citing works
The first cases of Candida auris candidaemia in Oman
Mohsin, J., Hagen, F., Al‐Balushi, Z. A. M., de Hoog, S., Chowdhary, A., Meis, J. F. G. M., & Al‐Hatmi, A. M. S. (2017) · Mycoses · doi:10.1111/myc.12647 · Cited by 84 · see citing works
Self-citationFirst reported case of multidrug-resistant Candida auris in Canada
Schwartz, I. S., & Hammond, G. (2017) · Canada Communicable Disease Report · doi:10.14745/ccdr.v43i78a02 · Cited by 70 · see citing works
Manastır, L., Ergon, M. C., & Yücesoy, M. (2009) · Mycoses · doi:10.1111/j.1439-0507.2009.01766.x · Cited by 53 · see citing works
Ribeiro, M. A., & Paula, C. R. (2006) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/j.diagmicrobio.2006.04.019 · Cited by 49 · see citing works
Pfaller, M. A., Boyken, L. B., Hollis, R. J., Kroeger, J. S., Messer, S. A., Tendolkar, S., & Diekema, D. J. (2008) · Journal of Clinical Microbiology · doi:10.1128/jcm.01391-08 · Cited by 47 · see citing works
Khillan, V., Rathore, N., Kathuria, S., & Chowdhary, A. (2014) · JMM Case Reports · doi:10.1099/jmmcr.0.t00018 · Cited by 45 · see citing works
Self-citationXisto, M. I. D. D. S., Caramalho, R., Rocha, D. A. S., Ferreira‐Pereira, A., Sartori, B., Barreto‐Bergter, E., Junqueira, M. L., Lass‐Flörl, C., & Lackner, M. (2016) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkw558 · Cited by 44 · see citing works
Pfaller, M. A., Boyken, L. B., Hollis, R. J., Kroeger, J. S., Messer, S. A., Tendolkar, S., & Diekema, D. J. (2011) · Journal of Clinical Microbiology · doi:10.1128/jcm.02437-10 · Cited by 34 · see citing works
Reboutier, D., Piednoël, M., Boisnard, S., Conti, A., Chevalier, V., Florent, M., Gibot‐Leclerc, S., Silva, B. D., Chastin, C., Fallague, K., et al. (2008) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/j.diagmicrobio.2008.10.019 · Cited by 20 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- [13]13. Magobo RE, Corcoran C, Seetharam S et al. Candida auris associated can- didemia, South Africa. Emerg Infect Dis 2014; 20: 1250-1.
- [30]30. Clinical and Laboratory Standards Institute. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts; Approved Standard-Third Edition: CLSI Document M27-A3. CLSI, Wayne, PA, USA, 2008.
- [38]38. Xisto MI, Caramalho RD, Rocha DA et al. Pan-azole-resistant Candida tro- picalis carrying homozygous erg11 mutations at position K143R: a new emerging superbug? J Antimicrob Chemother 2017; 72: 988-92.
Cited by
Sorted by citations
Antifungal Drug Resistance: Molecular Mechanisms in <i>Candida albicans</i> and Beyond
Lee, Y., Puumala, E., Robbins, N., & Cowen, L. E. (2021) · Chemical Reviews · doi:10.1021/acs.chemrev.0c00199 · Cited by 801 · see citing works
Drug resistance and tolerance in fungi.
Berman, J., & Krysan, D. J. (2020) · Nature Reviews Microbiology · doi:10.1038/s41579-019-0322-2 · Cited by 654 · see citing works
The Antifungal Pipeline: Fosmanogepix, Ibrexafungerp, Olorofim, Opelconazole, and Rezafungin
Hoenigl, M., Sprute, R., Egger, M., Arastehfar, A., Cornely, O. A., Krause, R., Lass-Flörl, C., Prattes, J., Spec, A., Thompson, G. R., et al. (2021) · Drugs · doi:10.1007/s40265-021-01611-0 · Cited by 467 · see citing works
Muñoz, J. F., Gade, L., Chow, N. A., Loparev, V. N., Juieng, P., Berkow, E. L., Farrer, R. A., Litvintseva, A. P., & Cuomo, C. A. (2018) · Nature Communications · doi:10.1038/s41467-018-07779-6 · Cited by 458 · see citing works
Chow, N. A., Muñoz, J. F., Gade, L., Berkow, E., Li, X., Welsh, R. M., Forsberg, K., Lockhart, S. R., Adam, R., Alanio, A., et al. (2020) · doi:10.1101/2020.01.06.896548 · Cited by 463 · see citing works
<i>Candida auris</i> : The recent emergence of a multidrug-resistant fungal pathogen
Forsberg, K., Woodworth, K., Walters, M., Berkow, E. L., Jackson, B., Chiller, T., & Vallabhaneni, S. (2019) · Medical Mycology · doi:10.1093/mmy/myy054 · Cited by 421 · see citing works
Ruiz‐Gaitán, A., Moret, A. M., Tasias‐Pitarch, M., Aleixandre‐López, A. I., Martínez‐Morel, H., Calabuig, E., Salavert‐Lletí, M., Ramírez, P., López‐Hontangas, J. L., Hagen, F., et al. (2018) · Mycoses · doi:10.1111/myc.12781 · Cited by 343 · see citing works
Self-citationGlobal epidemiology of emerging Candida auris
Rhodes, J., & Fisher, M. C. (2019) · Current Opinion in Microbiology · doi:10.1016/j.mib.2019.05.008 · Cited by 315 · see citing works
Molecular mechanisms governing antifungal drug resistance
Lee, Y., Robbins, N., & Cowen, L. E. (2023) · npj Antimicrobials and Resistance · doi:10.1038/s44259-023-00007-2 · Cited by 304 · see citing works
Ahmad, S., & Alfouzan, W. (2021) · Microorganisms · doi:10.3390/microorganisms9040807 · Cited by 269 · see citing works
Understanding Echinocandin Resistance in the Emerging Pathogen Candida auris
Kordalewska, M., Lee, A., Park, S., Berrio, I., Chowdhary, A., Zhao, Y., & Perlin, D. S. (2018) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00238-18 · Cited by 247 · see citing works
Self-citationGenomic epidemiology of the UK outbreak of the emerging human fungal pathogen <i>Candida auris</i>
Rhodes, J., Abdolrasouli, A., Farrer, R. A., Cuomo, C. A., Aanensen, D. M., Armstrong-James, D., Fisher, M. C., & Schelenz, S. (2018) · Emerging Microbes & Infections · doi:10.1038/s41426-018-0045-x · Cited by 246 · see citing works
Review on Antifungal Resistance Mechanisms in the Emerging Pathogen Candida auris
Chaabane, F., Graf, A., Jequier, L., & Coste, A. T. (2019) · Frontiers in Microbiology · doi:10.3389/fmicb.2019.02788 · Cited by 223 · see citing works
Kean, R., Delaney, C., Sherry, L., Borman, A., Johnson, E. M., Richardson, M. D., Rautemaa-Richardson, R., Williams, C., & Ramage, G. (2018) · mSphere · doi:10.1128/msphere.00334-18 · Cited by 220 · see citing works
Carolus, H., Pierson, S., Muñoz, J. F., Subotić, A., Cruz, R. B., Cuomo, C. A., & Van Dijck, P. (2021) · mBio · doi:10.1128/mbio.03333-20 · Cited by 211 · see citing works
Rybak, J. M., Muñoz, J. F., Barker, K. S., Parker, J. E., Esquivel, B. D., Berkow, E. L., Lockhart, S. R., Gade, L., Palmer, G. E., White, T. C., et al. (2020) · mBio · doi:10.1128/mbio.00365-20 · Cited by 202 · see citing works
Candida auris Pan-Drug-Resistant to Four Classes of Antifungal Agents
Jacobs, S. E., Jacobs, J. L., Dennis, E. K., Taimur, S., Rana, M., Patel, D., Gitman, M., Patel, G., Schaefer, S., Iyer, K., et al. (2022) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00053-22 · Cited by 190 · see citing works
Confirmation of fifth <i>Candida auris</i> clade by whole genome sequencing
Spruijtenburg, B., Badali, H., Abastabar, M., Mirhendi, H., Khodavaisy, S., Sharifisooraki, J., Taghizadeh Armaki, M., de Groot, T., & Meis, J. F. (2022) · Emerging Microbes & Infections · doi:10.1080/22221751.2022.2125349 · Cited by 164 · see citing works
Self-citationHealey, K. R., Kordalewska, M., Jiménez Ortigosa, C., Singh, A., Berrío, I., Chowdhary, A., & Perlin, D. S. (2018) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01427-18 · Cited by 165 · see citing works
Self-citationChen, J., Tian, S., Han, X., Chu, Y., Wang, Q., Zhou, B., & Shang, H. (2020) · BMC Infectious Diseases · doi:10.1186/s12879-020-05543-0 · Cited by 159 · see citing works
<i>Candida auris</i> Genetics and Emergence
Chowdhary, A., Jain, K., & Chauhan, N. (2023) · Annual Review of Microbiology · doi:10.1146/annurev-micro-032521-015858 · Cited by 158 · see citing works
Self-citationRybak, J. M., Doorley, L. A., Nishimoto, A. T., Barker, K. S., Palmer, G. E., & Rogers, P. D. (2019) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00057-19 · Cited by 141 · see citing works
The Quiet and Underappreciated Rise of Drug-Resistant Invasive Fungal Pathogens
Arastehfar, A., Lass-Flörl, C., Garcia-Rubio, R., Daneshnia, F., Ilkit, M., Boekhout, T., Gabaldon, T., & Perlin, D. S. (2020) · Journal of Fungi · doi:10.3390/jof6030138 · Cited by 145 · see citing works
Self-citationFungal persister cells: The basis for recalcitrant infections?
Wuyts, J., Van Dijck, P., & Holtappels, M. (2018) · PLOS Pathogens · doi:10.1371/journal.ppat.1007301 · Cited by 136 · see citing works
Antifungal Resistance: a Concerning Trend for the Present and Future
Hendrickson, J. A., Hu, C., Aitken, S. L., & Beyda, N. (2019) · Current Infectious Disease Reports · doi:10.1007/s11908-019-0702-9 · Cited by 139 · see citing works
Sabino, R., Veríssimo, C., Pereira, Á. A., & Antunes, F. (2020) · Microorganisms · doi:10.3390/microorganisms8020181 · Cited by 133 · see citing works
Candida auris Infection and Biofilm Formation: Going Beyond the Surface
Horton, M. V., & Nett, J. E. (2020) · Current Clinical Microbiology Reports · doi:10.1007/s40588-020-00143-7 · Cited by 132 · see citing works
Clade-specific chromosomal rearrangements and loss of subtelomeric adhesins in <i>Candida auris</i>
Muñoz, J. F., Welsh, R. M., Shea, T., Batra, D., Gade, L., Howard, D., Rowe, L. A., Meis, J. F., Litvintseva, A. P., & Cuomo, C. A. (2021) · Genetics · doi:10.1093/genetics/iyab029 · Cited by 125 · see citing works
Self-citationIbrexafungerp: A First-in-Class Oral Triterpenoid Glucan Synthase Inhibitor
Jallow, S., & Govender, N. P. (2021) · Journal of Fungi · doi:10.3390/jof7030163 · Cited by 129 · see citing works
Rybak, J. M., Barker, K. S., Muñoz, J. F., Parker, J. E., Ahmad, S., Mokaddas, E., Abdullah, A., Elhagracy, R. S., Kelly, S. L., Cuomo, C. A., et al. (2022) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2021.11.024 · Cited by 120 · see citing works
Khan, Z., Ahmad, S., Al-Sweih, N., Joseph, L., Alfouzan, W., & Asadzadeh, M. (2018) · PLOS ONE · doi:10.1371/journal.pone.0195743 · Cited by 109 · see citing works
Rybak, J. M., Cuomo, C. A., & David Rogers, P. (2022) · Current Opinion in Microbiology · doi:10.1016/j.mib.2022.102208 · Cited by 113 · see citing works
Innate immune responses against the fungal pathogen Candida auris
Wang, Y., Zou, Y., Chen, X., Li, H., Yin, Z., Zhang, B., Xu, Y., Zhang, Y., Zhang, R., Huang, X., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-31201-x · Cited by 107 · see citing works
Epidemiology of Invasive Candidiasis
Bays, D., Jenkins, E., Lyman, M., Chiller, T., Strong, N., Ostrosky-Zeichner, L., Hoenigl, M., Pappas, P., & Thompson, G. (2024) · Clinical Epidemiology · doi:10.2147/clep.s459600 · Cited by 109 · see citing works
“122,123 122–124 Because of the potential for person-to-person transmission with C. auris , infection prevention measures are key to preventing nosocomial spread.”
BackgroundKenters, N., Kiernan, M., Chowdhary, A., Denning, D. W., Pemán, J., Saris, K., Schelenz, S., Tartari, E., Widmer, A., Meis, J. F., et al. (2019) · International Journal of Antimicrobial Agents · doi:10.1016/j.ijantimicag.2019.08.013 · Cited by 102 · see citing works
Self-citationAntifungal Resistance in Candida auris: Molecular Determinants
Frías-De-León, M. G., Hernández-Castro, R., Vite-Garín, T., Arenas, R., Bonifaz, A., Castañón-Olivares, L., Acosta-Altamirano, G., & Martínez-Herrera, E. (2020) · Antibiotics · doi:10.3390/antibiotics9090568 · Cited by 93 · see citing works
Eldesouky, H. E., Li, X., Abutaleb, N. S., Mohammad, H., & Seleem, M. N. (2018) · International Journal of Antimicrobial Agents · doi:10.1016/j.ijantimicag.2018.08.016 · Cited by 90 · see citing works
Burrack, L. S., Todd, R. T., Soisangwan, N., Wiederhold, N. P., & Selmecki, A. (2022) · mBio · doi:10.1128/mbio.00842-22 · Cited by 82 · see citing works
Bing, J., Hu, T., Zheng, Q., Muñoz, J. F., Cuomo, C. A., & Huang, G. (2020) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01466-20 · Cited by 86 · see citing works
Novel <i>ERG11</i> and <i>TAC1b</i> Mutations Associated with Azole Resistance in Candida auris
Li, J., Coste, A. T., Liechti, M., Bachmann, D., Sanglard, D., & Lamoth, F. (2021) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.02663-20 · Cited by 82 · see citing works
Maphanga, T. G., Naicker, S. D., Kwenda, S., Muñoz, J. F., van Schalkwyk, E., Wadula, J., Nana, T., Ismail, A., Coetzee, J., Govind, C., et al. (2021) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00517-21 · Cited by 78 · see citing works
Update on the Pathogenesis, Virulence, and Treatment of Candida auris
Watkins, R. R., Gowen, R., Lionakis, M., & Ghannoum, M. (2022) · Pathogens and Immunity · doi:10.20411/pai.v7i2.535 · Cited by 68 · see citing works
Mechanisms of pathogenicity for the emerging fungus Candida auris
Horton, M. V., Holt, A. M., & Nett, J. E. (2023) · PLOS Pathogens · doi:10.1371/journal.ppat.1011843 · Cited by 67 · see citing works
Hou, X., Lee, A., Jiménez-Ortigosa, C., Kordalewska, M., Perlin, D. S., & Zhao, Y. (2019) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01811-18 · Cited by 66 · see citing works
Self-citationSpruijtenburg, B., Ahmad, S., Asadzadeh, M., Alfouzan, W., Al‐Obaid, I., Mokaddas, E., Meijer, E. F. J., Meis, J. F., & de Groot, T. (2023) · Mycoses · doi:10.1111/myc.13655 · Cited by 61 · see citing works
Self-citationDeciphering the Mrr1/Mdr1 Pathway in Azole Resistance of Candida auris
Li, J., Coste, A. T., Bachmann, D., Sanglard, D., & Lamoth, F. (2022) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00067-22 · Cited by 59 · see citing works
Sharma, D., Paul, R. A., Rudramurthy, S. M., Kashyap, N., Bhattacharya, S., Soman, R., Shankarnarayan, S. A., Chavan, D., Singh, S., Das, P., et al. (2022) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01652-21 · Cited by 60 · see citing works
Shivarathri, R., Jenull, S., Stoiber, A., Chauhan, M., Mazumdar, R., Singh, A., Nogueira, F., Kuchler, K., Chowdhary, A., & Chauhan, N. (2020) · mSphere · doi:10.1128/msphere.00973-20 · Cited by 59 · see citing works
Self-citationSingh, A., Healey, K. R., Yadav, P., Upadhyaya, G., Sachdeva, N., Sarma, S., Kumar, A., Tarai, B., Perlin, D. S., & Chowdhary, A. (2018) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00195-18 · Cited by 56 · see citing works
Self-citationInternational Multicentre Study of Candida auris Infections
Pandya, N., Cag, Y., Pandak, N., Pekok, A. U., Poojary, A., Ayoade, F., Fasciana, T., Giammanco, A., Caskurlu, H., Rajani, D. P., et al. (2021) · Journal of Fungi · doi:10.3390/jof7100878 · Cited by 56 · see citing works
Fungal resistance to echinocandins and the MDR phenomenon in Candida glabrata
Healey, K., & Perlin, D. S. (2018) · doi:10.20944/preprints201808.0306.v1 · Cited by 194 · see citing works
Self-citationAsadzadeh, M., Mokaddas, E., Ahmad, S., Abdullah, A. A., de Groot, T., Meis, J. F., & Shetty, S. A. (2022) · Mycoses · doi:10.1111/myc.13419 · Cited by 55 · see citing works
Self-citationAl-Hatmi, A., de Hoog, G. S., & Meis, J. F. (2019) · Infection and Drug Resistance · doi:10.2147/idr.s180912 · Cited by 47 · see citing works
Self-citationDickwella Widanage, M. C., Singh, K., Li, J., Yarava, J. R., Scott, F. J., Xu, Y., Gow, N. A. R., Mentink-Vigier, F., Wang, P., Lamoth, F., et al. (2025) · Nature Communications · doi:10.1038/s41467-025-61678-1 · Cited by 51 · see citing works
In vitro antifungal activity of a novel topical triazole PC945 against emerging yeast Candida auris
Rudramurthy, S. M., Colley, T., Abdolrasouli, A., Ashman, J., Dhaliwal, M., Kaur, H., Armstrong-James, D., Strong, P., Rapeport, G., Schelenz, S., et al. (2019) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkz280 · Cited by 44 · see citing works
Al-Obaid, I., Asadzadeh, M., Ahmad, S., Alobaid, K., Alfouzan, W., Bafna, R., Emara, M., & Joseph, L. (2022) · Journal of Fungi · doi:10.3390/jof8030267 · Cited by 39 · see citing works
Fayed, B., Jayakumar, M. N., & Soliman, S. S. M. (2021) · Medical Mycology · doi:10.1093/mmy/myab059 · Cited by 41 · see citing works
Jenull, S., Shivarathri, R., Tsymala, I., Penninger, P., Trinh, P.-C., Nogueira, F., Chauhan, M., Singh, A., Petryshyn, A., Stoiber, A., et al. (2022) · mBio · doi:10.1128/mbio.00799-22 · Cited by 32 · see citing works
“auris can differ strikingly at both the inter- and intraclade levels (12, 14).”
BackgroundInfluentialSelf-citationUpc2-mediated mechanisms of azole resistance in <i>Candida auris</i>
Li, J., Aubry, L., Brandalise, D., Coste, A. T., Sanglard, D., & Lamoth, F. (2024) · Microbiology Spectrum · doi:10.1128/spectrum.03526-23 · Cited by 33 · see citing works
Transcriptome Signatures Predict Phenotypic Variations of Candida auris
Jenull, S., Tscherner, M., Kashko, N., Shivarathri, R., Stoiber, A., Chauhan, M., Petryshyn, A., Chauhan, N., & Kuchler, K. (2021) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2021.662563 · Cited by 32 · see citing works
Transcriptional and translational landscape of <i>Candida auris</i> in response to caspofungin
Zamith-Miranda, D., Amatuzzi, R. F., Munhoz da Rocha, I. F., Martins, S. T., Lucena, A. C. R., Vieira, A. Z., Trentin, G., Almeida, F., Rodrigues, M. L., Nakayasu, E. S., et al. (2021) · Computational and Structural Biotechnology Journal · doi:10.1016/j.csbj.2021.09.007 · Cited by 29 · see citing works
Nanotechnology-Based Strategies to Combat Multidrug-Resistant Candida auris Infections
Hetta, H. F., Ramadan, Y. N., Al-Kadmy, I. M. S., Ellah, N. H. A., Shbibe, L., & Battah, B. (2023) · Pathogens · doi:10.3390/pathogens12081033 · Cited by 24 · see citing works
Four genomic clades of <i>Candida auris</i> identified in Canada, 2012–2019
De Luca, D. G., Alexander, D. C., Dingle, T. C., Dufresne, P. J., Hoang, L. M., Kus, J. V., Schwartz, I. S., Mulvey, M. R., & Bharat, A. (2022) · Medical Mycology · doi:10.1093/mmy/myab079 · Cited by 22 · see citing works
Cha, H., Won, D., & Bahn, Y.-S. (2025) · mBio · doi:10.1128/mbio.02475-23 · Cited by 19 · see citing works
Antifungal Activity of Plant Secondary Metabolites on Candida albicans: An Updated Review
Khan, A., Moni, S. S., Ali, M., Mohan, S., Jan, H., Rasool, S., Kamal, M. A., Alshahrani, S., Halawi, M., & Alhazmi, H. A. (2023) · Current Molecular Pharmacology · doi:10.2174/1874467215666220304143332 · Cited by 17 · see citing works
A Comparative Transcriptome Between Anti-drug Sensitive and Resistant Candida auris in China
Zhou, W., Li, X., Lin, Y., Yan, W., Jiang, S., Huang, X., Yang, X., Qiao, D., & Li, N. (2021) · Frontiers in Microbiology · doi:10.3389/fmicb.2021.708009 · Cited by 16 · see citing works
Salama, E. A., Elgammal, Y., Wijeratne, A., Lanman, N. A., Utturkar, S. M., Farhangian, A., Li, J., Meunier, B., Hazbun, T. R., & Seleem, M. N. (2024) · Emerging Microbes & Infections · doi:10.1080/22221751.2024.2322649 · Cited by 16 · see citing works
Candida auris skin tropism and antifungal resistance are mediated by carbonic anhydrase Nce103
Phan-Canh, T., Coman, C., Lackner, M., Troppmair, N., Müller, C., Cerbu, D., Seiser, S., Penninger, P., Tsymala, I., Khunweeraphong, N., et al. (2025) · Nature Microbiology · doi:10.1038/s41564-025-02189-z · Cited by 16 · see citing works
“1c) 15,21 , thus explaining pronounced echinocandin resistance traits in R1 and R2.”
Self-citationExploring synergy between azole antifungal drugs and statins for <i>Candida auris</i>
Halliday, C., Kim, H. Y., Tay, E., Chen, S. C. A., & Alffenaar, J.-W. (2023) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkad303 · Cited by 14 · see citing works
Psychogenetic, genetic and epigenetic mechanisms in Candida auris: Role in drug resistance
Rabaan, A. A., Eljaaly, K., Alfouzan, W. A., Mutair, A. A., Alhumaid, S., Alfaraj, A. H., Aldawood, Y., Alsaleh, A. A., Albayat, H., Azmi, R. A., et al. (2023) · Journal of Infection and Public Health · doi:10.1016/j.jiph.2022.12.012 · Cited by 14 · see citing works
- Authors
- Chowdhary, A., Prakash, A., Sharma, C., Kordalewska, M., Kumar, A., Sarma, S., Tarai, B., Singh, A., Upadhyaya, G., Upadhyay, S., Yadav, P., Singh, P. K., Khillan, V., Sachdeva, N., Perlin, D. S., & Meis, J. F.
- Affiliations
- University of Delhi (IN)
- Rutgers Health (US)
- Amrita Institute of Medical Sciences and Research Centre (IN)
- Medanta The Medicity (IN)
- Max Healthcare (IN)
- Institute of Liver and Biliary Sciences (IN)
- Rajiv Gandhi Cancer Institute and Research Centre (IN)
- Radboud University Nijmegen (NL)
- Corresponding author
- Chowdhary, Anuradha
- ORCID
- Venue
- Journal of Antimicrobial Chemotherapy
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-01-09
- Volume
- 73
- Issue
- 4
- Pages
- 891-899
- ISSN
- 0305-7453 (ISSN-L)
- 1460-2091
- OpenAlex
- W2784269063
- Semantic Scholar
- 05ec71cd81788fb8266600d6f811c37f09cebef8
- Cited by
- 577
- References
- 44
- Citations by year
- 2026: 66 · 2025: 65 · 2024: 57 · 2023: 75 · 2022: 64 · 2021: 78 · 2020: 77 · 2019: 54 · 2018: 36
- FWCI
- 35.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Antimicrobial Chemotherapy (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Indian Council of Medical Research (5/3/3/26/2010-ECD-I)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Fungal and yeast genetics research
- Keywords
- Candida auris, antifungal susceptibility, multidrug resistance, azole resistance, fluconazole resistance, echinocandin resistance, ERG11, FKS1, gene expression profiling, amphotericin B resistance, nosocomial fungal infections, India
- MeSH terms
- Antifungal Agents, Azoles, Candida, Candidiasis, Female, Fungal Proteins, Genotype, Humans, India, Male, Microbial Sensitivity Tests, Middle Aged, Mutation, Sequence Analysis, DNA, Gene Expression Profiling, Drug Resistance, Fungal, Echinocandins
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
