Abstract
Candida auris is an invasive healthcare-associated fungal pathogen. Cases of candidemia, defined as illness in patients with Candida cultured from blood, were detected through national laboratory-based surveillance in South Africa during 2016–2017. We identified viable isolates by using mass spectrometry and sequencing. Among 6,669 cases (5,876 with species identification) from 269 hospitals, 794 (14%) were caused by C. auris. The incidence risk for all candidemia at 133 hospitals was 83.8 (95% CI 81.2–86.4) cases/100,000 admissions. Prior systemic antifungal drug therapy was associated with a 40% increased adjusted odds of C. auris fungemia compared with bloodstream infection caused by other Candida species (adjusted odds ratio 1.4 [95% CI 0.8–2.3]). The crude in-hospital case-fatality ratio did not differ between Candida species and was 45% for C. auris candidemia, compared with 43% for non–C. auris candidemia. C. auris has caused a major epidemiologic shift in candidemia in South Africa.
Highlights
Candida auris is an invasive healthcare-associated fungal pathogen
The crude in-hospital case-fatality ratio did not differ between Candida species and was 45% for C. auris candidemia, compared with 43% for non–C. auris candidemia (p = 0.6) (C. albicans, 50%; C. parapsilosis, 32%; C. glabrata, 51%) (Table 2)
In conducting this comprehensive national survey, we found that C. auris caused >10% of all cases of candidemia in South Africa and was the third most common Candida species
Summary
During the 2-year surveillance period, 6,669 cases of candidemia (6,629 first and 40 recurrent episodes) were detected across South Africa at 103 public-sector and 166 privatesector hospitals (2,529 cases [38%] in the public sector, 4,140 cases [62%] in the private sector). Of the 6,669 cases, viable isolates were identified to species level at NICD for 3,020 (45%) cases. Species identification was available for a further 2,856 cases (2,842 from private laboratories, 14 from NHLS laboratories). Among 5,876 cases with a species-level identification, 794 (14%) were caused by C. auris and 5,082 (86%) by other Candida species Twenty-nine cases had a mixed episode of candidemia caused by C. auris and another Candida species (mostly C. parapsilosis [21 cases]). The total incidence risk for candidemia (expressed as cases/100,000 hospital admissions) at 115 private-sector and 18 public-sector hospitals with available admissions data was 71.2 (95% CI 68.6–73.8) in the private sector and 149.5 (95% CI 141.1–158.1) in the public sector, for a total of 83.8 (95% CI 81.2–86.4]) (Table 1). Among 435 patients with C. auris candidemia for whom data were available
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