Genomic epidemiology and antifungal-resistant characterization of Candida auris, Colombia, 2016-2021

Since 2016 in Colombia, ongoing transmission of Candida auris has been reported in multiple cities. Here, we provide an updated description of C. auris genomic epidemiology and the dynamics of antifungal resistance in Colombia. We sequenced 99 isolates from C. auris cases with collection dates ranging from June 2016 to January 2021; the resulting sequences coupled with 103 previously generated sequences from C. auris cases were described in a phylogenetic analysis. All C. auris cases were of clade IV. Of the 182 isolates with antifungal susceptibility data, 67 (37%) were resistant to fluconazole, and 39 (21%) were resistant to amphotericin B. Isolates predominately clustered by country except for 16 isolates from Bogota, Colombia, which grouped with isolates from Venezuela. The largest cluster (N=166 isolates) contained two subgroups. The first subgroup contained 26 isolates, mainly from Cesar; of these 85% (N=22) were resistant to fluconazole. The second subgroup consisted of 47 isolates from the north coast; of these, 81% (N=38) were resistant to amphotericin B. Mutations in the ERG11 and TAC1B genes were identified in fluconazole-resistant isolates, and two amino acid substitutions in PSK76257-(FLO8) and PSK74852 genes were associated with higher minimum inhibitory concentration values for amphotericin B. This work may help identify mechanisms conferring azole and amphotericin B resistance in C. auris. Overall, C. auris cases from different geographic locations in Colombia exhibited high genetic relatedness, suggesting continued transmission between cities since 2016. These findings also suggest a lack of or minimal introductions of different clades of C. auris into Colombia. IMPORTANCECandida auris is an emerging fungus that presents a serious global health threat and has caused multiple outbreaks in Colombia. This work discusses the likelihood of introductions and local transmission of C. auris and provides an updated description of the molecular mechanisms associated with antifungal resistance in Colombia. Efforts like this tracking genomic variation provide information about the evolving C. auris burden that could help guide public health strategies to control C. auris spread.