Abstract
The multi-resistant yeast Candida auris has become a global public health threat because of its ease to persist and spread in clinical environments, especially in intensive care units. One of the most severe manifestations of invasive candidiasis is candidaemia, whose epidemiology has evolved to more resistant non-albicans Candida species, such as C. auris. It is crucial to establish infection control policies in order to control an outbreak due to nosocomial pathogens, including the implementation of screening colonisation studies. We describe here our experience in managing a C. auris outbreak lasting more than two and a half years which, despite our efforts in establishing control measures and surveillance, is still ongoing. A total of 287 colonised patients and 47 blood stream infections (candidaemia) have been detected to date. The epidemiology of those patients with candidaemia and the susceptibility of C. auris isolates are also reported. Thirty-five patients with candidaemia (74.5%) were also previously colonised. Forty-three patients (91.5%) were hospitalised (61.7%) or had been hospitalised (29.8%) in the ICU before developing candidaemia. Antifungal therapy for candidaemia consisted of echinocandins in monotherapy or in combination with amphotericin B or isavuconazole. The most common underlying disease was abdominal surgery (29.8%). The thirty-day mortality rate was 23.4% and two cases of endophtalmitis due to C. auris were found. All isolates were resistant to fluconazole and susceptible to echinocandins and amphotericin B. One isolate became resistant to echinocandins two months after the first isolate. Although there are no established clinical breakpoints, minimum inhibitory concentrations for isavuconazole were low (≤ 1 μg/mL).
Highlights
An increase in the prevalence of Candida bloodstream infections and a shift in the epidemiology have been observed in recent years, especially since the emergence of the multidrug-resistant yeast Candida auris [1]
When a colonised or infected patient is discharged to a general ward, surveillance is performed, and when a case is detected outside the intensive care units (ICU), surveillance cultures are performed to contacts in the ward
Environmental surveillance is performed in the ICU once a year or when an increase in the number of cases is produced, and C. auris has been isolated from mattresses. tables, computers and an emergency button
Summary
An increase in the prevalence of Candida bloodstream infections (candidaemia) and a shift in the epidemiology have been observed in recent years, especially since the emergence of the multidrug-resistant yeast Candida auris [1]. C. auris was first identified in 2009, from the auditory canal of a Japanese patient [2] and, since it has been reported in a large variety of body parts and in the six continents of the world [3] This yeast is considered a growing menace to global health for several reasons, which include its resistance to multiple commonly used antifungals, its problematic. Antibiotics 2020, 9, 558 identification in the laboratory and its facility to spread among patients, causing nosocomial outbreaks, especially in intensive care units (ICU) [4] Different organisations, such as Centers for Disease Control and Prevention (CDC) or the European Centre for Disease Prevention and Control (ECDC), claim that there is an emergency in using reliable methods to identify Candida spp. isolates to the species level and encourage hospitals to do screening colonisation studies in order to control the outbreaks caused by. We analyse the evolution in the Candida species distribution causing candidaemia in our setting since 2011 and the clinical and epidemiological characteristics of all patients diagnosed with C. auris candidaemia, as well as the antifungal susceptibility of the isolates
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