EPIDEMIOLOGY AND SUSCEPTIBILITY PATTERN OF CANDIDA VULTURNA IN MALAYSIA: A MULTIDRUG RESISTANCE SPECIES AND CLOSELY RELATED TO CANDIDA AURIS

Abstract

Intro: Candida auris has emerged as a serious global health threat by the Centres for Disease Control and Prevention (CDC). This has drawn attention to another multidrug-resistant species, i.e., C. vulturna, a new member of C. haemulonii complex and it is closely related to C. auris. Methods: A total of 19 isolates (n=19) of C. vulturna had been isolated from blood of immunocompromised patients in Malaysian. Yeast dentification results were documented using physiological and biochemical techniques. Molecular identification of the isolates was accomplished by PCR-sequencing techniques. Phylogenetic analysis was done to investigate the genetic relatedness of C. vulturna to other Candida species. Antifungal susceptibility test was performed using commercialised Vitek system against various antifungal agents. The minimum inhibitory concentrations (MICs) and interpretive criteria for antifungals were following CLSI (2017). Findings: Out of 19 cases of C. vulturna infections, 47% (n=9) of the cases were reported from Sabah, followed by three cases from Klang Valley, two cases from Sarawak and five cases from other states. All isolates matched 99.7 to 100% similarity to the reference strain of C. vulturna 11-1170. Isolates of C. vulturna were resistant to amphotericin B, fluconazole and voriconazole. They were moderately resistant to itraconazole. In contrast, C. vulturna isolates showed susceptible to anidulafungin and caspofungin. Discussion: Generally, C. vulturna was isolated from all over Malaysian states, especially in Sabah. PCR-sequencing enable for an accurate identification of the species. Similarly with C. auris, C. vulturna displayed multi-drug resistant to azoles and amphotericin B. Conclusion: Our results indicate that, C. vulturna has emerge as an important opportunistic human pathogen and require more attention as C. auris, due to the difficulty to identify and resistance to antifungals. Their ability to transmitted within a healthcare facility and may cause healthcare associated outbreaks should be monitored.