Yihui Wang,* Li Lin,* Jiahao Li,* Xiaoyue Wang, Junmin Zhang, Liyan Xi, Wenying Cai, Sha Lu

Department of Dermatology and Venereology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Sha Lu, Email lush7@mail.sysu.edu.cn

Background: Candida auris is an emerging multidrug-resistant yeast associated with high transmission rates in healthcare settings. This study investigates C. auris infections/colonization in a single institution to elucidate their clinical and epidemiological patterns, with the ultimate aim of informing infection control measures.
Objective: To characterize the genetic basis of antifungal resistance in C. auris, specifically through ERG11 gene mutation analysis, and correlate these findings with clinical outcomes and epidemiological data. The results are intended to guide the development of targeted strategies for outbreak prevention and resistance mitigation.
Methods: A case series study of seven C. auris-infected/colonized patients (May–September 2023 and April 2024) was conducted. Epidemiological and clinical data were collected, and ITS and SNP analyses were used to examine genetic relationships and resistance profiles, focusing on fluconazole, amphotericin B, and ERG11 gene mutations.
Results: All seven C. auris isolates were fluconazole resistant, with three also resistant to amphotericin B. ITS and SNP analysis identified two geographic clades (I and III), with clade III strains sharing ERG11 mutations (V125A, F126L) and one clade I strain showing the Y132F mutation. These markers shed light on resistance mechanisms and clade-specific clustering. All patients were elderly individuals (≥ 64 years old) with severe underlying conditions admitted to the ICU. After C. auris was detected, their treatment became delayed or inefficient, resulting in poor clinical outcomes.
Conclusion: This study highlights the value of SNP and ITS analysis in uncovering genetic diversity and adaptation in C. auris. The consistent mutations in Clades I and III enhance our understanding of the genetic mechanisms influencing ERG11 gene variability across clades. Additionally, the challenges in managing multidrug-resistant C. auris infections, especially in elderly patients with severe comorbidities, emphasize the urgent need for effective surveillance, infection control, and new antifungal agents.

Keywords: Candida auris, candidemia, epidemiological trends, clinical characteristics, drug resistance profile, prevention strategy