Science1 publisher2 min readPublished
Nairobi surgical infection yields a C. auris strain resistant to every antifungal tested
A Candidozyma auris isolate from a Nairobi surgical-site infection resisted all four classes of antifungal drug in laboratory tests, researchers report. That makes it the first pan-drug-resistant case of the WHO critical-priority pathogen reported in Africa.
The Scientist · Science desk
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What happened
- The isolate came from a 28-year-old woman who had elective surgery in Nairobi, and her wound swab grew the yeast after a hospital-acquired infection set in.
- Genomic typing placed the fungus in one of the clades already linked to high levels of antifungal resistance.
- First described in 2009, C. auris has reached more than 60 countries across six continents and caused outbreaks inside hospitals.
- In some settings, invasive C. auris infections have killed between 30 and 50 percent of the patients they struck.
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Why it matters
- constraint A pan-drug-resistant strain leaves clinicians no antifungal to escalate to, so for a case like this the realistic goal becomes containment.
- exposure The authors say the danger is sharpest where newer antifungals are hard to obtain, the situation across much of the region where this case arose.
- precedent The Nairobi mutations do not match the earlier New York case, so a hospital finding pan-drug resistance can no longer assume it was imported from an outbreak elsewhere.
The genome shows how the resistance is built, class by class. Changes in the genes ERG11 and CDR1 cover the azoles, the group that includes fluconazole; an alteration in FKS1 covers the echinocandins caspofungin and micafungin; and a stop-gain mutation in FUR1, the gene that processes flucytosine, covers that drug [10]. In the lab the isolate held off all five agents: fluconazole, caspofungin, micafungin, amphotericin B and flucytosine [8].
Those tests were done in the laboratory, so they describe the isolate, not the course of the woman's illness [5]. And they describe one isolate. This is only the second pan-drug-resistant C. auris documented anywhere [16]. A case report can show that such a strain exists and how it is assembled; it cannot say how common pan-drug resistance is, or whether this lineage will travel. The yeast is already known to move between patients and persist on hospital surfaces [1].
The researchers could not say what produced the resistance here. The patient was given several antifungal drugs during her illness, but the records lacked the doses and durations that would tie her treatment to the mutations [12].
They call for stronger surveillance of fungal genomes and for "rapid diagnostic capacity to mitigate the spread of highly resistant C. auris lineages in healthcare settings," they write in the paper, published in Scientific Reports [14][15].
What to watch
- Whether surveillance turns up more pan-drug-resistant C. auris, which would move this from a single case report to a trend.
- Whether genome comparisons confirm the Kenyan resistance arose independently of the 2022 New York lineage.
- Whether the WHO or national health agencies update C. auris containment guidance in response.