Emergence and Genomic Profiling of Multidrug-Resistant Candida auris Isolated from Intensive Care Unit Patients in a Malaysian Teaching Hospital

Candida auris, a significant pathogen causing invasive candidiasis with high mortality rates and frequent hospital outbreaks, is understudied in Malaysia. This study retrospectively examined invasive candidiasis cases at Universiti Malaya Medical Centre from 2018 to 2021. Four C. auris strains were isolated from blood and peritoneal samples of intensive care unit patients and identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Antifungal susceptibility testing using Sensititre™ YeastOne YO10 plate showed resistance to amphotericin B (2-4 µg/ml) and fluconazole (256 µg/ml) but susceptibility to echinocandins. Whole-genome sequencing revealed a 12.31 Mb genome, 45.59% G + C content, 99.95-99.99% average nucleotide identity between the isolates, and 190-225 single nucleotide polymorphisms. The Malaysian strains were phylogenetically related to the South Asian Clade (I) and harbored mutations associated with resistance to fluconazole (ERG11 gene: Y132F; CDR1 gene: E709D) and amphotericin B (ERG2 gene: E39D). The first genomic characterization of multidrug-resistant C. auris in Malaysian ICU patients highlights the urgent need for enhanced infection control measures in healthcare settings.