Comparison of antifungal sensitivity profile of multiresistant emerging yeast isolates Candida auris recovered from fungemias, candidiasis and colonization processes in Colombia.

On the occasion of the "Global Emergency Alert for Invasive Infections Caused by Multidrug Resistant Yeast Candida auris", issued by the National Institute of Health in September 2016, approximately 120 clinical isolates associated with different forms of presentation of the infection have been received, including fungemia, candidiasis or colonization by multidrug-resistant yeast C. auris. One of the characteristics of this yeast is its multiresistance; some isolates of C. auris present minimum inhibitory concentrations (MIC) elevated to the three main classes of antifungals, limiting the therapeutic options. In Colombia, preliminary studies indicate that in Colombia, strains of this yeast with elevated MIC values circulate to the most used antifungal treatments: fluconazole and amphotericin B.
Outbreaks have been characterized in at least 4 medical institutions in three departments of the country, with a mortality superior to 50%, in patients with a wide range of age; the characterization of these outbreaks has allowed to recover the yeast of the hospital environment, indicating that this pathogen has the capacity to contaminate the environment close to the patient, becoming a microorganism of high importance in the group of those involved in the IAAS.
Currently, it is evident that C. auris has emerged as an important nosocomial pathogen, transmitted inter and intra-hospitalally in a clonal manner, widely dispersed in different regions of the world, associated with high mortality, therapeutic failure and resistance to several classes of antifungal agents.
Determining the sensitivity profile of clinical isolates of C. auris to an ample panel of antifungal agents is of great importance considering the multiresistance capacity of this yeast, as well as establishing whether there are differences in the sensitivity of the strains according to their association with fungemia or candidiasis, in order to give timely management and treatment to patients, consequently reducing the very high morbidity and mortality.

Candida, Colombia, fungemia, candidiasis, antifungal susceptibility, antifungal sensitivity

El proyecto proveerá información sobre la resistencia a antifúngicos de aislamientos clínicos de la levadura emergente multiresistente C. auris, mediante la determinación del perfil de sensibilidad a 9 agentes empleando la técnica de oro de microdilución en caldo. La comparación que se realizará entre aislamientos provenientes de procesos de colonización y aquellos de procesos invasivos permitirá determinar si las cepas colonizadoras tienen un perfil de sensibilidad diferente a las recuperadas de fungemias y candidiasis, haciendo que éstas últimas presenten valores de concentración inhibitoria mínima (CIM) más elevados debido a posibles alteraciones que el patógeno adquiere cuando hace el cambio de comensal a patógeno.
Adicionalmente, la caracterización de las cepas en cuanto a su perfil de sensibilidad antifúngica servirá como insumo para posteriores investigaciones encaminadas a la determinación de posibles marcadores de resistencia al fluconazol y las equinocandinas, lo cual es de gran importancia para el tratamiento óptimo de las infecciones causadas por C. auris, ya que junto con la determinación del perfil de sensibilidad, suministra información relevante sobre los mecanismos de resistencia de esta levadura que en algunos casos puede presentar resistencia a hasta 3 familias de antifúngicos.