Abstract
(1) Background: Candida auris has been reported as emerging yeast pathogen that can cause invasive bloodstream infections in healthcare settings. It is associated with high mortality rates and resistance to multiple classes of antifungal drugs and is difficult to identify with standard laboratory methods. (2) Methods: We conducted a retrospective review of epidemiological, clinical, and microbiological records for 23 C. auris fungemia cases at the Royal Hospital, a tertiary care facility in Oman, between 2016 and 2018. Demographic data, risk factors associated with mortality, microbiology investigation and treatment regimens are described. Yeasts were identified by MALDI-TOF. (3) Results: We identified 23 patients with C. auris fungemia. All positive samples from patients were confirmed as C. auris using MALDI-TOF, and ITS-rDNA sequencing. Microsatellite genotyping showed that the Omani isolates belong to the South Asian clade I. The majority of patients had multiple underlying illnesses and other risk factors that have been associated with fungemia. All isolates were non-susceptible to fluconazole. Isolates from all patients were sensitive to echinocandins and these were used as first line therapy. (4) Conclusions: Candida auris affects adults and children with a variety of risk factors including central venous catheters and overuse of antibiotics. Infections occur in both immunocompromised and immunocompetent individuals. Mortality was high in this series, and the organism can be transmitted in healthcare settings. Programs for raising awareness in Oman hospitals are warranted. Caspofungin remains 1st line therapy as MICs are still low despite its wide use.
Highlights
Bloodstream fungal infections are a significant cause of mortality in immunocompromised patients, including AIDS, organ transplant recipients, hematology and oncology patients and patients requiring invasive therapies [1]
In the United States, over 30% of cases of candidemia are caused by C. glabrata, and about 20% of cases caused by C. parapsilosis [5], whereas C. parapsilosis is mainly reported from Australia, Europe and
Risk factors, treatment, and outcomes associated with C. auris fungemia at our institution during a 4-year period from 2016 through 2019
Summary
Bloodstream fungal infections are a significant cause of mortality in immunocompromised patients, including AIDS, organ transplant recipients, hematology and oncology patients and patients requiring invasive therapies [1]. Candida spp. account for 70 to 80% of invasive bloodstream fungal infections, in ICU patients, and they represent the fourth most common nosocomial bloodstream infection [2,3,4]. Antibiotics 2020, 9, 638 recent worldwide studies showed that the epidemiological landscape of candidemia is shifting toward an increasing prevalence of non-albicans species, C. tropicalis, C. glabrata, C. parapsilosis [5]. Most recently C. auris, which has emerged globally causing up to 60% of candidemia cases [6,7]. Candida auris is currently one of the most common clinical fungal pathogens, causing nosocomial infections [7]. Because of higher drug-resistance rate, C. auris is more difficult to treat, requires longer hospitalization periods, and results in higher morbidity and mortality than other Candida species [14]
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