An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital

Abstract

Multidrug-resistant Candida auris has emerged as a cause of insidious hospital outbreaks and complicated infections. We present the analysis of an ongoing C. auris outbreak including the largest published series of C. auris bloodstream infection. All C. auris-positive patients from April-2016 to January-2017 were included. Environmental, clinical and microbiological data were recorded. Definitive isolate identification was performed by ITS-rDNA sequencing, and typing by amplified fragment length polymorphism fingerprinting. One hundred and forty patients were colonised by C. auris during the studied period (68% from surgical intensive care). Although control measures were implemented, we were not able to control the outbreak. Forty-one invasive bloodstream infections (87.8% from surgical intensive care) were included. Clinical management included prompt intravascular catheter removal and antifungal therapy with echinocandins. All isolates were fluconazole- and voriconazole-resistant, but echinocandin- and amphotericin B-susceptible. Thirty-day mortality rate was 41.4%, and severe septic metastasis as spondylodiscitis and endocarditis were observed in 5 patients (12%). C. auris was also recovered from inanimate patient surroundings and medical equipment. Despite antifungal treatment, high mortality and late complication rates were recorded. Molecular typing suggested a clonal outbreak different from those previously published.

Diagnosis, management and prevention of Candida auris in hospitals: position statement of the Australasian Society for Infectious Diseases

“…Similarly, in New York, 98% of isolates were ‘resistant’ to fluconazole, and 25% ‘resistant’ to both fluconazole and amphotericin B . In Spain, all isolates were fluconazole‐ and voriconazole‐‘resistant’, whilst none was ‘resistant’ to echinocandins or amphotericin B . In an UK outbreak most strains were ‘susceptible’ to echinocandins …”

“…auris was isolated from wounds, rectal and pharyngeal swabs, respiratory samples and urine during screening in Spanish and UK outbreaks, and persisted for weeks . The ratio of colonised to infected patients was 2–3:1 . Colonisation reappeared after apparent clearance in some cases .…”

“…The proportion of candidaemia cases varied with different outbreak reports (Table ). In a Spanish outbreak, metastatic complications of candidaemia such as bone and heart valve infection occurred in 12% of patients . Thirty‐day mortality for invasive candidiasis was 41.4% .…”

“…In a Spanish outbreak, metastatic complications of candidaemia such as bone and heart valve infection occurred in 12% of patients . Thirty‐day mortality for invasive candidiasis was 41.4% . Another study indicated in‐hospital mortality as 59% and a systematic review reported a crude mortality rate of 30% for patients infected or colonised with C .…”

“…Healthcare outbreaks have been reported from at least eight countries . Some outbreaks from Europe and USA are summarised in Table . Where tested, healthcare workers (HCW) were not found to be colonised during outbreaks in the UK and Spain …”