AUTHOR=Asadzadeh Mohammad , Ahmad Suhail , Al-Sweih Noura , Khan Ziauddin 

TITLE=Molecular fingerprinting by multi-locus sequence typing identifies microevolution and nosocomial transmission of Candida glabrata in Kuwait

JOURNAL=Frontiers in Public Health

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1242622

DOI=10.3389/fpubh.2023.1242622

ISSN=2296-2565

ABSTRACT=<sec id="sec1"><title>Backgrounds</title><p><italic>Candida glabrata</italic> is a frequently isolated non-<italic>albicans Candida</italic> species and invasive <italic>C. glabrata</italic> infections in older patients are associated with high mortality rates. Opportunistic <italic>Candida</italic> infections in critically ill patients may be either endogenous or nosocomial in origin and this distinction is critical for effective intervention strategies. This study performed multi-locus sequence typing (MLST) to study genotypic relatedness among clinical <italic>C. glabrata</italic> isolates in Kuwait.</p></sec><sec id="sec2"><title>Methods</title><p><italic>Candida glabrata</italic> isolates (<italic>n</italic> = 91) cultured from 91 patients were analyzed by MLST. Repeat isolates (<italic>n</italic> = 16) from 9 patients were also used. Antifungal susceptibility testing for fluconazole, voriconazole, caspofungin and amphotericin B (AMB) was determined by Etest. Genetic relatedness was determined by constructing phylogenetic tree and minimum spanning tree by using BioNumerics software.</p></sec><sec id="sec3"><title>Results</title><p>Resistance to fluconazole, voriconazole and AMB was detected in 7, 2 and 10 <italic>C. glabrata</italic> isolates, respectively. MLST identified 28 sequence types (STs), including 12 new STs. ST46 (<italic>n</italic> = 33), ST3 (<italic>n</italic> = 8), ST7 (<italic>n</italic> = 6) and ST55 (<italic>n</italic> = 6) were prevalent in ≥4 hospitals. Repeat isolates obtained from same or different site yielded identical ST. No association of ST46 with source of isolation or resistance to antifungals was apparent. Microevolution and cross-transmission of infection was indicated in two hospitals that yielded majority (57 of 91, 67%) of <italic>C. glabrata</italic>.</p></sec><sec id="sec4"><title>Conclusion</title><p>Our data suggest that <italic>C. glabrata</italic> undergoes microevolution in hospital environment and can be nosocomially transmitted to other susceptible patients. Thus, proper infection control practices during routine procedures on <italic>C. glabrata</italic>-infected patients may prevent transmission of this pathogen to other hospitalized patients.</p></sec>