A case of Candida auris candidemia in Xiamen, China, and a comparative analysis of clinical isolates in China

Figures & data

Figure 1. Phylogenic analyses of the C. auris strains isolated from China compared to other C. auris strains. The two strains (XM1803 and XM1805) isolated from Xiamen, China, are highlighted in green and the other isolates from China are highlighted in red. Twenty-one additional C. auris isolates representing the five genetic clades are also included (highlighted in black). The maximum-likelihood phylogenetic tree was generated based on ITS sequences. The scale bar indicates the number of nucleotide substitutions per site.

Table 1. MICs and Erg11 mutations of the 20 C. auris clinical isolates from China

MIC (μg/mL)	FLC	ITC	POS	VRC	AMB	5-FC	AFG	CAS	MFG	Data adapted from	Erg11 mutation hot spot
XM1803	128	0.5	0.125	0.5	2	0.125	0.5	0.25	0.125	This study	VF125AL
XM1805	128	0.5	0.25	0.5	2	0.125	0.5	0.5	0.25	This study	VF125AL
BJCA001	2	0.03	0.02	0.0	0.25	<0.06	0.12	0.06	0.06	Reference 1	No mutation
C1921	128	0.25	0.25	0.5	2	0.125	0.5	0.5	0.25	This study	VF125AL
C1922	128	0.5	0.25	0.5	2	0.125	1	0.5	0.25	This study	VF125AL
RICU1	256	0.06	0.03	0.5	0.5	<0.06	0.03	0.06	0.06	Reference 2	VF125AL
RICU2	256	0.12	0.06	1.0	0.5	<0.06	0.12	0.12	0.12	Reference 2	VF125AL
RICU3	256	0.06	0.03	0.5	0.5	<0.06	0.12	0.06	0.06	Reference 2	VF125AL
RICU4	256	0.12	0.06	1.0	0.5	<0.06	0.12	0.12	0.12	Reference 2	VF125AL
RICU5	256	0.06	0.03	0.5	0.5	<0.06	0.12	0.12	0.12	Reference 2	VF125AL
RICU6	128	0.12	0.03	0.5	0.5	<0.06	0.12	0.12	0.12	Reference 2	VF125AL
RICU7	256	0.12	0.06	1.0	0.5	<0.06	0.12	0.12	0.12	Reference 2	VF125AL
RICU8	256	0.06	0.03	0.5	0.5	<0.06	0.12	0.06	0.06	Reference 2	VF125AL
NICU1	256	0.06	0.03	0.5	0.5	<0.06	0.12	0.06	0.06	Reference 2	VF125AL
NICU2	256	0.12	0.06	1.0	1	<0.06	0.12	0.12	0.12	Reference 2	VF125AL
NICU3	256	0.12	0.06	0.5	0.5	<0.06	0.12	0.12	0.12	Reference 2	VF125AL
NICU4	256	0.12	0.06	1.0	0.5	<0.06	0.12	0.12	0.12	Reference 2	VF125AL
NICU5	256	0.06	0.03	0.5	0.5	<0.06	0.12	0.06	0.06	Reference 2	VF125AL
NICU6	256	0.06	0.03	0.5	0.5	<0.06	0.12	0.06	0.06	Reference 2	VF125AL
NSICU1	256	0.06	0.03	0.5	0.5	<0.06	0.12	0.06	0.06	Reference 2	VF125AL

FLC fluconazole, ITC itraconazole, POS posaconazole, VRC voriconazole, AMB amphotericin B, 5-FC 5-flucytosine, AFG anidulafungin, CAS caspofungin, MFG micafungin, MIC minimal inhibitory concentration (μg/mL).

References

1. Wang XJ, Bing J, Zheng QS, Zhang FF, Liu JB, Yue HZ, Tao L, Du H, Wang YN, Wang H, et al. 2018. The first isolate of Candida auris in China: clinical and biological aspects. Emerg Microbes Infec. 7(1): 93.

2. Tian S, Rong C, Nian H, Li F, Chu Y, Cheng S, Shang H. 2018. First cases and risk factors of super yeast Candida auris infection or colonisation from Shenyang, China. Emerg Microbes Infect. 7(1): 128.

Table 2. Clinical information of the 20 C. auris clinical isolates from mainland China

Location	Isolates name		Source	Year of Identification	Age/Gender	Reference
Xiamen	XM1803	Clade III	Drainage tube tip	2018	67‐year‐old, male	This study
	XM1805	Clade III	Blood	2018	67‐year‐old, male	This study
Beijing	BJCA001	Clade I	BALF	2018	76-year-old, female	1
	C1921	Clade III	Blood	2018	preterm male infants	2
	C1922	Clade III	Blood	2018	Preterm male infants	2
Shenyang	RICU1	Clade III	Urine	2017	70-year-old, male	3
	RICU2	Clade III	Urine	2017	69-year-old, female	3
	RICU3	Clade III	Sputum	2017	69-year-old, female	3
	RICU4	Clade III	Blood	2017	56-year-old, male	3
	RICU5	Clade III	Catheter	2017	82-year-old, female	3
	RICU6	Clade III	Catheter	2017	70-year-old, male	3
	RICU7	Clade III	Urine	2017	63-year-old, female	3
	RICU8	Clade III	Urine	2017	73-year-old, female	3
	NICU1	Clade III	Urine	2017	60-year-old, female	3
	NICU2	Clade III	Urine	2017	58-year-old, male	3
	NICU3	Clade III	Urine	2017	86-year-old, male	3
	NICU4	Clade III	Urine	2017	49-year-old, male	3
	NICU5	Clade III	Urine	2017	86-year-old, female	3
	NICU6	Clade III	Drainage	2017	82-year-old, female	3
	NSICU1	Clade III	Urine	2017	53-year-old, male	3
BALF, bronchoalveolar lavage fluid

Reference

1. Wang XJ, Bing J, Zheng QS, Zhang FF, Liu JB, Yue HZ, Tao L, Du H, Wang YN, Wang H, et al. 2018. The first isolate of Candida auris in China: clinical and biological aspects. Emerg Microbes Infec. 7(1): 93.

2. Chen Y, Zhao JY, Han L, Qi LH, Fan WH, Liu J, Wang ZG, Xia X, Chen J, Zhang LL. 2018. Emergency of fungemia cases caused by fluconazole-resistant Candida auris in Beijing, China. Journal of Infection. 77(6): 569–571.

3. Tian S, Rong C, Nian H, Li F, Chu Y, Cheng S, Shang H. 2018. First cases and risk factors of super yeast Candida auris infection or colonisation from Shenyang, China. Emerg Microbes Infect. 7(1): 128.

Figure 2. PCR analyses of the MTL loci of the different C. auris strains isolated from China. The MTL loci (MTLa or MTLα) of the twenty C. auris strains isolated from China were determined by PCR chemotyping.

Figure 3. Colony and cellular morphologies of the different C. auris strains. Strains XM1803, XM1805, C1921, C1922, NSICU1, RICU4, and BJCA001 were isolated from China. The MTLa strains, CBS12766 and B11245, were isolated from India and Venezuela, respectively. Yeast-form cells were plated onto YPD medium supplemented 5 μg/mL of phloxine B and incubated at 25°C for seven days. Scale bar = 10 μm.

Figure 4. Sap expression for the different C. auris strains. Strains XM1803, XM1805, C1921, C1922, NSICU1, RICU4, and BJCA001 were isolated from China. The MTLa strains, CBS12766 and B11245, were isolated from India and Venezuela, respectively. Approximately 5 × 10⁶ yeast-form cells of each strain in 5 μL ddH₂O were spotted onto YCB-BSA medium plates and incubated at 25°C or 37°C for seven days. The white precipitation zones (halos) indicate the activity of the Saps. The widths (mm) of the zones were measured and shown below the corresponding image (n = 3). N/A = no obvious halos were observed.

Data availability

All data generated or analysed during this study are included in this published article.