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Application of Novel Short Tandem Repeat Typing for Wickerhamomyces anomalus Reveals Simultaneous Outbreaks within a

Bram Spruijtenburg1,2, Shivaprakash M Rudramurthy3, Eelco F J Meijer1,2

  • 1Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands.

Microorganisms
|June 28, 2023
PubMed

Insights

A novel short tandem repeat (STR) typing scheme rapidly identified multiple Wickerhamomyces anomalus outbreaks in healthcare settings. This method aids in tracking yeast infections and understanding antifungal resistance, particularly in vulnerable neonates.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Genetics

Background:

  • Wickerhamomyces anomalus (formerly Candida pelliculosa) causes severe candidemia, especially in neonates, with high mortality and emerging fluconazole resistance.
  • Outbreaks of W. anomalus are frequent in healthcare facilities, particularly neonatal intensive care units (NICUs), necessitating rapid diagnostic tools.

Purpose of the Study:

  • To develop and validate a high-resolution short tandem repeat (STR) typing scheme for W. anomalus.
  • To apply the STR scheme to identify and track outbreak events.
  • To investigate antifungal susceptibility and genetic mechanisms of resistance.

Main Methods:

  • Development of a multiplex PCR-based STR typing scheme with six markers for W. anomalus.
  • Genotyping of 90 W. anomalus isolates and comparison with whole-genome sequencing (WGS) SNP data.
  • Antifungal susceptibility testing and WGS analysis of ERG11 genes for resistance mechanisms.

Main Results:

  • The STR scheme identified 38 distinct genotypes among 90 isolates, revealing four major clusters indicative of simultaneous outbreaks.
  • STR typing results showed high concordance with WGS SNP analysis.
  • Reduced fluconazole susceptibility was observed in 2.3% of isolates, with a novel I469L substitution in ERG11 identified in one isolate.

Conclusions:

  • The novel STR genotyping scheme is effective for high-resolution typing and outbreak detection of W. anomalus.
  • This method facilitates rapid identification of infection sources and transmission patterns in clinical settings.
  • Understanding genetic diversity and resistance mechanisms is crucial for managing W. anomalus infections.
Keywords:
Candida pelliculosaWickerhamomyces anomalusantifungal susceptibility testinggenotypingoutbreak investigationshort tandem repeatswhole-genome sequencing

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