A swab was taken from the wound and grown in the laboratory.
Researchers have found in Nairobi a notorious fungus that
resisted all four major classes of antifungal medicines tested, making it the
first such case documented in Africa and only the second in the world.
The fungus, called Candidozyma auris, formerly Candida auris,
was found in a 28-year-old woman who developed an infection at a surgical wound
while being treated at a tertiary hospital in the city.
Researchers from the Kenya Medical Research Institute
(Kemri) and the Walter Reed Army Institute of Research-Africa, who reported the
finding, said this is concerning because C. auris is already known to spread
easily in hospitals and can colonise patients for long periods.
It can cause serious infections of wounds, the bloodstream
and urinary tract. It can also spread from one part of the body into the blood
and become life-threatening.
The World Health Organization has classified C. auris as a
critical priority fungal pathogen because of its drug resistance and its
potential to spread. Some studies estimate a mortality rate of 30 per cent to 53 per cent of patients affected by an invasive infection.
“Pan-drug-resistant (PDR) isolates, resistant to four
antifungal classes, are exceedingly rare, previously reported from a single
patient in New York, US (2022). We report phenotypic and genomic features of a
PDR C. auris isolate from Kenya, the second globally,” the researchers
wrote.
They called this an alarming threat in places with few treatment options.
Their report, titled
“Emergence of pan-drug resistant Candidozyma auris in Kenya, the second
globally documented case”, was published online on September 29 in the
journal Scientific Reports.
C. Auris is one of the world’s most feared hospital microbes.
The Kenyan woman underwent elective surgery last year but later
developed a hospital-acquired infection at the surgical site, with pus.
The woman received multiple antibiotics and antifungal drugs over eight months, from February to October.
When her fever did not clear, a swab was taken from
the wound and was grown in the laboratory.
Tests showed the isolate resisted
fluconazole, caspofungin, micafungin, amphotericin B and flucytosine. These
medicines belong to four major groups of antifungal drugs.
A fifth drug, voriconazole, was also measured, but the
researchers could not interpret the result because no official cut-off exists.
The team also read the fungus’s DNA using whole-genome
sequencing. They found several genetic changes already linked to resistance,
and two mutations they describe as new.
The researchers say the resistance may have developed
independently in Kenya, although they cannot establish exactly how it arose.
They could also not rule out the possibility that it was brought into Kenya from an unsampled source.
“Clinically, the emergence of a PDR C. auris in Kenya
poses a substantial threat to patient care, particularly in resource-limited
settings where novel antifungal agents such as ibrexafungerp are not widely
available,” they said.
The researchers called for robust surveillance, rapid
diagnostic capacity and strict antifungal stewardship to prevent further
spread of drug-resistant pathogens.
“These findings underscore the critical importance of robust
antifungal stewardship, infection prevention, and rapid diagnostic capacity to
mitigate the spread of highly resistant C. auris lineages in healthcare
settings,” they said.
“Continued expansion of C. auris surveillance across Kenyan healthcare
facilities will be important for defining its epidemiology, transmission
dynamics, antifungal resistance and genetic diversity.”
The authors include Erick Odoyo, Collins Kigen, James
Wachira, Vanessa Natasha, Stephen Ondolo, Martin Georges and Allan Wataka.
Others are Luis Pow Sang, Robert C Haynes and Lillian Musila. The US Army health surveillance programme funded the work.
Drug-resistant infections are already a serious problem in Kenya. The Institute for Health Metrics and Evaluation estimated that about 6,670 deaths in Kenya in 2021 were associated with antimicrobial resistance, meaning resistance contributed to the deaths.
The Kemri-Wellcome Trust Research Programme says countries like Kenya suffer disproportionately because they have restricted access to third- and fourth-line drugs, the medicines given when standard treatment fails.
A recent four-year study of children admitted to a national referral hospital found that 73 of the 113 deaths among children with resistant infections were attributable to the resistance.