Candida kefyr in Kuwait: Prevalence, antifungal drug susceptibility and genotypic heterogeneity

Suhail Ahmad 1, Ziauddin Khan 1, Noura Al-Sweih 1, Wadha Alfouzan 1, Leena Joseph 1, Mohammad Asadzadeh 1

Affiliations

27 October 2020

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doi: 10.1371/journal.pone.0240426

Abstract

Objective: Candida kefyr causes invasive candidiasis in immunocompromised patients, particularly among those with oncohematological diseases. This study determined the prevalence of C. kefyr among yeast isolates collected during 2011-2018 in Kuwait. Antifungal susceptibility testing (AST) and genotypic heterogeneity among C. kefyr was also studied.

Methods: Clinical C. kefyr isolates recovered from bloodstream and other specimens during 2011 to 2018 were retrospectively analyzed. All C. kefyr isolates were identified by CHROMagar Candida, Vitek2 and PCR amplification of rDNA. AST was performed by Etest. Molecular basis of resistance to fluconazole and echinocandins was studied by PCR-sequencing of ERG11 and FKS1, respectively. Genotypic heterogeneity was determined with microsatellite-/minisatellite-based primers and for 27 selected isolates by PCR-sequencing of IGS1 region of rDNA.

Results: Among 8257 yeast strains, 69 C. kefyr (including four bloodstream) isolates were detected by phenotypic and molecular methods. Isolation from urine and respiratory samples from female and male patients was significantly different (P = 0.001). Four isolates showed reduced susceptibility to amphotericin B and one isolate to all (amphotericin B, fluconazole, voriconazole and caspofungin/micafungin) antifungals tested. Fluconazole-resistant isolate contained only synonymous mutations in ERG11. Echinocandin-resistant isolate contained wild-type hotspot-1 and hotspot-2 of FKS1. Fingerprinting with microsatellite-/minisatellite-based primers identified only three types. IGS1 sequencing identified seven haplotypes among 27 selected isolates.

Conclusions: The overall prevalence of C. kefyr among clinical yeast isolates and among candidemia cases was recorded as 0.83% and 0.32%, respectively. The frequency of isolation of C. kefyr from bloodstream and other invasive samples was stable during the study period. The C. kefyr isolates grown from invasive (bloodstream, bronchoalveolar lavage, abdominal drain fluid, peritonial fluid and gastric fluid) samples and amphotericin B-resistant isolates were genotypically heterogeneous strains.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Dendrogram based on unweighted pair group method with arithmetic mean (UPGMA) and derived from intergenic spacer (IGS)-1 sequence data for 27 C. kefyr isolates. The source of isolation and susceptibility to amphotericin B (AMB) are also shown for each isolate.

Fig 1. Dendrogram based on unweighted pair group method with arithmetic mean (UPGMA) and derived from intergenic spacer (IGS)-1 sequence data for 27 C. kefyr isolates. The source of isolation and susceptibility to amphotericin B (AMB) are also shown for each isolate.

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