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Occurrence of successive cases of invasive C. auris infections with resulting mortality in nine patients suggests persistence of this multidrug-resistant yeast in major hospitals in Kuwait. Early detection by continuous surveillance and enforcement of infection control measures are recommended.

Candida auris is an emerging yeast pathogen that has recently caused major outbreaks in healthcare facilities worldwide. Clinical C. auris isolates are usually resistant to fluconazole and readily develop resistance to echinocandins and amphotericin B (AMB) during treatment. We describe here an interesting case of C. auris infection in an immunocompromised patient who had previously received AMB and caspofungin treatment. Subsequently, C. auris was isolated from tracheal (tracheostomy) secretions and twice from urine and all three isolates were susceptible to AMB and micafungin. The patient received a combination therapy with AMB and caspofungin. Although the C. auris was cleared from the urine, the patient subsequently developed breakthrough candidemia and the bloodstream isolate exhibited a reduced susceptibility to micafungin and also showed the presence of a novel (S639T) mutation in hotspot-1 of FKS1. Interestingly, C. auris from the tracheal (tracheostomy) secretions recovered one and four days later exhibited a reduced susceptibility to micafungin and S639Y and S639T mutations in hotspot-1 of FKS1, respectively. Although the treatment was changed to voriconazole, the patient expired. Our case highlights a novel FKS1 mutation and the problems clinicians are facing to treat invasive C. auris infections due to inherent or developing resistance to multiple antifungal drugs and limited antifungal armamentarium.

Moraxella osloensis has been reported in the literature as a rare cause of sepsis, central nervous system infection, chest infection, and endophthalmitis. In the present case, the organism was isolated from the blood of an 8-year-old immunocompetent boy. It could not be identified with VITEK-2 and API-20NE (bioMerieux SA, Marcy-l'Etoile, France). Latex-based bacterial antigen test (BD Directigen Meningitis Combo Test; Becton, Dickinson and Company, Sparks, Maryland, United States) was positive for Neisseria meningitidis A/Y. It was identified as M. osloensis using matrix-associated laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF) (Vitek MS, bioMerieux, Marcy-l'Etoile) (confidence level 99.9%) and 16S rRNA gene sequencing (99% sequence identity). The child responded well to ampicillin, and was discharged home after 4 days, on oral amoxicillin–clavulanic acid for the next 7 days. M. osloensis is a rare cause of bacteremia. It may masquerade as N. meningitidis in the routine tests performed in the routine microbiology laboratories. It is imperative to confirm the identification with MALDI-TOF or a molecular method to remove the false positive diagnosis of N. meningitidis, and to avoid the unnecessary use of prophylaxis with rifampicin or ciprofloxacin.

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