Objectives: Candida auris emerged as a human pathogen in 2009 and has subsequently been identified around the world as a cause of invasive candidiasis. We did an analysis from a single institution in order to analyze risk factors and outcomes for C. auris candidemia. Methods: Patients with candidemia were identified by the electronic medical record and reviewed for risk factors and outcome. Candida isolates were identified by Vitek2 as Candida haemulonii, but species determinations for 21 of the isolates using published molecular and proteomic methods identified all as C. auris. Findings: From September 2010 to December 2016, C. auris accounted for 38% of 201 patients with candidemia, while C. albicans contributed 25%. C. auris patients had been hospitalized longer (mean 32 days vs. 13 days; p < 0.001), were more likely to have central lines preceding candidemia than C. albicans patients (84% vs. 54%; p = < 0.001) and had more commonly been treated with carbapenems (83% vs 61% for C. albicans [p = 0.01]). The crude mortality was 29%, compared to 36% for C. albicans. Conclusions: These findings suggest an opportunistic pathogen that may be less virulent, but difficult to eradicate and that control efforts should focus on antimicrobial usage.

Low birth weight (LBW) and postnatal nutrition are risk factors for adult metabolic diseases. However, the interactions between LBW, diet, and intestinal lipid absorption and secretion leading to adult metabolic disease remain unclear. The current study determined the impact of LBW on intestinal lipid and carbohydrate metabolism under both control and Western diet (high fat, high fructose, and cholesterol) conditions in 5‐wk‐old LBW and normal birth weight (NBW) Landrace–Large White × Duroc pigs. A 2‐step modified oral glucose and fat challenge test was performed. Mesenteric lymph, jejunal mucosal scrapings, and cecal digesta samples were also collected. LBW offspring were lower in weight and gained less weight per day. LBW pigs on either control or Western diets displayed increased triglyceride (TG) secretion into lymph (P = 0.0135). Western diet‐fed LBW pigs developed fasting (P = 0.03) and postprandial (P < 0.05) hypertriglyceridemia, muscle steatosis (P = 0.0072), had higher insulin excursion (P < 0.01), increased jejunal stearoyl‐CoA desaturase 1 mRNA and increased hepatic fibrosis (P = 0.0017) compared with NBW piglets. Gut microbiota showed significant dysbiosis on Western diet independent of birth weight. In conclusion, LBW pigs fed a Western diet specifically up‐regulate TG absorption and secretion, develop dyslipidemia, muscular steatosis, and display early signs of insulin resistance. Interestingly, this study does not provide evidence of altered intestinal microbiome in LBW pigs contributing to increased severity of metabolic diseases.—Fontaine, M. A., Diane, A., Singh, V. P., Mangat, R., Krysa, J. A., Nelson, R., Willing, B. P., Proctor, S. D. Low birth weight causes insulin resistance and aberrant intestinal lipid metabolism independent of microbiota abundance in Landrace‐Large White pigs. FASEB J. 33, 9250–9262 (2019). http://www.fasebj.org

Objectives: Candida auris emerged as a human pathogen in 2009 and has subsequently been identified around the world as a cause of invasive candidiasis. We did an analysis from a single institution in order to analyze risk factors and outcomes for C. auris candidemia. Methods: Patients with candidemia were identified by the electronic medical record and reviewed for risk factors and outcome. Candida isolates were identified by Vitek2 as Candida haemulonii, but species determinations for 21 of the isolates using published molecular and proteomic methods identified all as C. auris. Findings: From September 2010 to December 2016, C. auris accounted for 38% of 201 patients with candidemia, while C. albicans contributed 25%. C. auris patients had been hospitalized longer (mean 32 days vs. 13 days; p < 0.001), were more likely to have central lines preceding candidemia than C. albicans patients (84% vs. 54%; p = < 0.001) and had more commonly been treated with carbapenems (83% vs 61% for C. albicans [p = 0.01]). The crude mortality was 29%, compared to 36% for C. albicans. Conclusions: These findings suggest an opportunistic pathogen that may be less virulent, but difficult to eradicate and that control efforts should focus on antimicrobial usage.

Background Candida auris emerged as a human pathogen in 2009 and has subsequently been identified around the world as a cause of invasive candidiasis. Published clinical information on this organism consists primarily of case reports and small case series; thus, data from a single institution will allow us to examine risk factors for acquiring C. auris candidemia in comparison to other Candida species.MethodsAga Khan University Hospital Nairobi is a 280-bed referral center with 50 critical care beds. Candida species account for 34% of hospital acquired bloodstream infections (Maina et al., 2016). Blood cultures were monitored continuously using the Bactec and the VitekII was used for identification and susceptibility. The VitekII identified C. auris as Candida haemulonii, but species determinations were done for 21 of the isolates and all were identified as C. auris using published methods (Pfaller et al., 2012).ResultsFrom September 2010 to December 2016, 201 patients had 228 episodes of candidemia. Further analyses were performed only for first episodes. C. auris accounted for 38% of candidemia cases and 25% for C. albicans. A case–control analysis was done to compare patients with C. auris vs. Candida albicans fungemia. C. auris patients were more likely to be from critical care beds (78% vs. 52%; P = 0.003) and had been hospitalized longer (mean 33 days vs. 13 days; P < 0.001) prior to the positive blood culture. There was a trend toward more pre-existing renal failure (39% vs. 24%; P = 0.09) in C. auris patients and during the two weeks prior to candidemia, they were more likely to have central lines (84% vs. 54%; P ≤ 0.001). C. auris patients received a mean of 3.35 antibiotic classes vs. 2.6 for C. albicans (P = 0.02). 75% of C. auris patients received carbapenems vs. 54% for C. albicans (P = 0.02). Eighteen percent of C. auris patients had ≥14 days of candidemia, despite frequent lack of followup blood cultures. Prolonged candidemia was not associated with development of in vitro resistance. The crude mortality was 29%, compared with 36% for C. albicans and 39% for other Candida spp. (NS).ConclusionThese findings suggest an opportunistic pathogen that may be less virulent, but difficult to eradicate and that control efforts should focus on antimicrobial usage.Disclosures M. Castanheira, Allergan: Research Contractor, Research support. M. A. Pfaller, Allergan: Research Contractor, Research support.

High-fat diets (HFD) have been shown to induce substantial shifts in intestinal microbial community composition and activity which are associated with adverse metabolic outcomes. Furthermore, changes in microbial composition are affected by fatty acid composition; saturated, monounsaturated (MUFA), and industrial trans fats (iTFA) adversely affect microbial diversity while polyunsaturated fats (PUFA) have been shown to have neutral effects. The effects of naturally occurring trans fats on gut microbial composition are unknown. Vaccenic acid (VA) is the most abundant naturally occurring trans fat (abundant in meat and dairy), can be elevated by altering a cow’s diet, and has been shown to have hypolipidemic effects. The aim of this study was to determine how variations of VA content in beef fat affect gut microbial composition, insulin resistance, and lipid metabolism in pigs. Low birth weight (LBW) and control pigs were fed a control or high-fat, high-carbohydrate (HFHC) diet supplemented with beef fat containing either high or low VA levels for 7 weeks. An adapted modified oral glucose tolerance test and fat challenge test were performed at 9 weeks of age following implantation of jugular catheters. Impacts on microbial composition were assessed using 16S rRNA gene amplicon sequencing. The HFHC diet containing beef fat rich in VA had a mild insulin sensitizing effect (p < 0.05, slope of curve), increased plasma HDL cholesterol (p < 0.05, +28%), reduced postprandial plasma TG (p < 0.05), and showed protection from HFHC-induced changes to gut microbial composition in LBW pigs as compared to HFHC diet containing standard beef fat. This is the first study to show effects of natural trans fats on gut dysbiosis; further studies are needed to elucidate mechanisms.

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