Candida auris Invasive Infection after Kidney Transplantation

Abstract

Introduction. C. auris has been associated not only with a variety of invasive fungal infections, including candidemia, sometimes related to central venous catheter, but also with pericarditis and respiratory tract and urinary tract infections. Materials and Methods. We describe the case of a patient with persistent fever despite antibiotics, who presented with Candida isolation in blood cultures, typified as Candida auris species. Results. A 57-year-old male receiving peritoneal dialysis underwent kidney transplantation which was complicated by primary nonfunction due to arterial thrombosis necessitating graft nephrectomy. During the postoperative period, he presented with Pseudomonas aeruginosa pneumonia that was treated with levofloxacin and catheter-related Enterococcus faecalis bacteremia treated with linezolid. After hospital discharge, he then presented with herpes zoster infection treated with valacyclovir. Ten days later, he developed peritonitis and exit site infection with multidrug-resistant Pseudomonas aeruginosa treated with intraperitoneal aztreonam and peritoneal dialysis catheter removal. Despite broad-spectrum antibiotic therapy, the patient remained febrile. All microbiology laboratory tests were negative, so it was decided to stop antibiotic therapy for 48 hours and repeat cultures in order to avoid possible false negatives. In new blood cultures performed after suspension of antibiotic therapy, candidemia was observed, later typified as Candida auris species. After completing antifungal treatment (three weeks with intravenous amphotericin B 100 mg qd and two weeks of intravenous anidulafungin 100 mg qd), microbiological cultures remained negative and the patient made uneventful recovery. Conclusion. Candida auris invasive infection has been mainly described in patients with severe underlying comorbidities and immunocompromise. Multidrug-resistant clusters of Candida auris are increasingly emerging.

Challenges and opportunities in stewardship among solid organ transplant recipients with Candida auris bloodstream infections

“…In vitro studies have also demonstrated synergistic activity of flucytosine when added to echinocandins, voriconazole, or amphotericin 21–23 . However, aside from a single case report of a kidney transplant recipient being treated successfully with 3 weeks of amphotericin and 2 weeks of anidulafungin, there is lack of real‐world data to support routine use of combination therapy for solid organ transplant recipients 24 . In our study, we had two patients with persistent fungemia whom we trialed combination therapy with micafungin plus ≥1 alternative agent (Table 1).…”

A fatal Candida albicans pericarditis presenting with cardiac tamponade after COVID‐19 infection and cardiothoracic surgery

“…Amphotericin B and surgical drainage have been reported successful 7 . Overall mortality due to this clinical entity is significantly high (75%) and is attributed mainly to difficulty in diagnosis due to subtle clinical clues and insidious onset 10 . Here, we report a fatal case of purulent pericarditis caused by Candida albicans presenting with cardiac tamponade after COVID‐19 infection and cardiothoracic surgery.…”

“…7 Overall mortality due to this clinical entity is significantly high (75%) and is attributed mainly to difficulty in diagnosis due to subtle clinical clues and insidious onset. 10 Here, we report a fatal case of purulent pericarditis caused by Candida albicans presenting with cardiac tamponade after COVID-19 infection and cardiothoracic surgery. The transthoracic echocardiography has demonstrated left ventricular (LV) hypertrophy with normal LV systolic function, abnormal interventricular septal motion, and septal shift (septal bounce), mild left atrial enlargement, significant respiratory variation mitral valve and tricuspid valve (more than 40%), thick aortic valve with mild aortic insufficiency, a thick pericardium with mild pericardial effusion with dilated inferior vena cava (IVC) without inspiratory collapse.…”

The epidemiology of invasive fungal infections in transplant recipients

“…Invasive candidiasis are most frequently observed in small bowel, pancreas, and liver transplant recipients, as many Candida species are natural commensals of the human gastrointestinal tract [ 5 , 17 ]. In the SOT population, C. albicans is the dominant pathogen, but an epidemiological trend toward non- albicans species has been observed in some studies [ [17] , [18] , [19] , [20] ]. Candida glabrata (now renamed Nakaseomyces glabratus ) is the most common of the non- C. albicans etiologic agent , accounting for approximately 40% of the total Candida isolates.…”

“…Candida parapsilosis (∼6%) and Candida krusei (now renamed Pichia kudriavzevii ) (∼5%) are also important pathogens in SOT recipients, especially in those who have received prior antifungal therapy [ 21 , 22 ]. Recently, Candida auris infections have been reported to cause outbreaks in liver and kidney transplant recipients [ 20 , 23 ]. Overall, invasive candidiasis remains associated with high rates of morbidity, mortality, and excess healthcare costs [ 24 ].…”