P438 Epidemiology, risk factor analysis and management of invasive Candida auris infections in tertiary care hepatobiliary center in India

Abstract

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectives Candida auris (C. auris) infections are associated with misidentification, intrahospital transmission, poor treatment outcomes, and higher mortalities. Prompt detection, earlier initiation of therapy and effective surveillance can curtail C. auris in hospitals. We aimed to study epidemiology, risk factors, and therapeutic management of invasive infections caused by C. auris in patients with hepatobiliary diseases.MethodsSingle-center, prospective study of patients with suspected invasive fungal infections between January2017-December 2021 in the patients with hepatobiliary diseases. Demographics, comorbidities, and laboratory variables were recorded. The positive yeast cultures were identified by VITEK 2 (Biomerieux, India) and antifungal sensitivity confirmed by Broth microdilution in accordance with CLSI guidelines. The final outcomes considered were mortality within 1 month after diagnosis or discharge of the patient with stable parameters.ResultsTotal of 189 isolates of C. auris from 73 patients, blood 25 (13.2%), abdominal fluids 29 (15.3%), urine 90 (47.6%), respiratory 7 (3.6%), liver abscess 2 (1.05%), pancreatic abscess 1 (0.5%), and wound infections 3 (1.5%). Underlying disease was chronic liver disease 49 (68%), 15 (20%) post liver transplant patients, acute on chronic liver failure 5 (7%), acute liver failure 2 (3%), acute pancreatitis 1 (1.3%), and pancreatic neuroendocrine tumor 1 (1.3%). 18 (25%) patients were discharged, the mortality was 54 (74.04%). Risk factors were MELD 40 (P .04), Child C (P .05), and CTP score above 12. Prior use of steroids (P .02), neutropenia (P .03), prolonged hospital stay (P .029), the use of broad-spectrum antibiotics ˃7 days (P .05) were the risk factors significantly associated with the development of C. auris infections, and higher mortality. Co-morbidities, acute renal failure, diabetes, and hepatitis infection were not significantly associated with mortality. The antifungal resistance: fluconazole 68.42%, voriconazole 14.03%, flucytosine 59.64%, and amphotericin B 28% with no resistance to caspofungin and micafungin.ConclusionOur study depicts the spectrum of invasive infections caused by C. auris, its prevalence, risk factors, and therapeutic options. The presence of risk factors, steroid use, neutropenia, broad-spectrum antibiotic use, and a hospital stay of ˃7 days should prompt toward escalating diagnostic measures for rapid identification of C. auris for early initiation of therapy. Active screening of patients with risk factors can also reduce mortality. The study results also help to guide empiric therapy with echinocandins as azoles and amphotericin B show high resistance in these isolates.