Three Candida auris Case Reports from Istanbul, Turkey

Abstract

Candida auris is a fungal pathogen that was first identified in 2009. Since its definition, it has spread globally and has caused life-threatening nosocomial infections. Increases in the number of immunocompromised individuals, empirical use of broad-spectrum antimicrobials and widespread use of catheterizations are the predisposing factors in the development of infection. There are problems for the identification of C.auris with the routine methods. In this case report, infections with C.auris, isolated for the first time from three patients in our hospital's intensive care units (ICU) between November 2020-January 2021, were presented. The first case was a 46-year-old male patient with laryngeal carcinoma who developed cardiopulmonary arrest during anesthesia induction in the tumor operation, and was followed up in the ICU. C.auris growth was detected in the blood and intravenous (IV) catheter tip cultures on the 66th day of admittance. Cure achieved on the 24th day under caspofungin treatment as no growth was determined. Second case was a 71-year-old female patient admitted to the emergency department with shortness of breath and general condition disorder that developed after COVID-19 infection and hospitalized in ICU with the diagnosis of pneumonia and acute renal failure. In the 16th day of admittance C.auris growth was detected in blood and from catheter tip cultures and the patient died in the 18th day. The third case was a 49-year-old male patient, followed up in ICU with the diagnosis of subarachnoid hemorrhage after he admitted to the emergency department with confusion. In the 35th day of admittance, 100000 CFU/ mL C auris growth was detected in urine culture. The patient was accepted as asymptomatic fungiuria and followed up in the ICU. It was determined that the three patients were intubated, had urinary and femoral venous catheters and were being followed under wide spectrum antibiotherapy when the growth of C.auris was detected. Isolates identified as C.auris by MALDI-TOF Microflex LT/SH Smart MS in the Medical Microbiology Laboratory were then confirmed by conventional methods and DNA sequencing in the National Mycology Reference Laboratory. Antifungal susceptibility tests were performed by broth microdilution method. Fluconazole MIC values were >256 mg/ml for all cases. Long-term survival in hospital environments, colonization on skin, resistance to disinfectants of C.auris, facilitate the spread of the fungi and resistance to antifungals lead to treatment failures. In this case report, it was aimed to draw attention to the infections with C.auris, its diagnosis and risk factors.