Clinical Outcomes of Patients Treated for Candida auris Infections in a Multisite Health System, Illinois, USA

Abstract

C andida auris is an emerging, multidrug-resistant, healthcare-associated fungal pathogen that was first reported in Japan in 2009 and has now been isolated on 6 continents (1-9). C. auris has been identified as the causative pathogen in various invasive fungal infections, including bloodstream infections (2,4), and is associated with outbreaks across healthcare settings (6,10). Risk factors for C. auris infection are similar to other Candida infections including prolonged hospitalization, abdominal surgery, diabetes mellitus, intensive care unit (ICU) admission, use of central venous and urinary catheters, immunocompromising conditions, chronic kidney disease, and exposure to broad-spectrum antibiotic and antifungal agents (10-13). Investigations in the Chicago, Illinois, USA, area have found a high prevalence of C. auris colonization at ventilator-capable skilled nursing facilities (14) and have shown higher rates of C. auris colonization among patients who are mechanically ventilated, have a gastrostomy tube, or have a urinary catheter (15). Reported mortality rates attributable to invasive C. auris infection range from 30% to 59% globally (13,16) and from 22% to 57% in the United States (8,10,17). C. auris isolates are often resistant to fluconazole and have variable susceptibility to other antifungal agents (13,16). The Centers for Disease Control and Prevention (CDC) currently recommends echinocandins as empiric therapy for suspected or confirmed C. auris infections (18). However, recent reports have indicated reduced susceptibilities to echinocandins and suggest that resistance might be inducible under antifungal pressure (8,16). Previous reports of C. auris infections and outbreaks have largely focused on epidemiologic information, and data on treatment strategies and clinical outcomes are limited (6,8,10,16-21). We report microbiologic data for C. auris isolates from a multisite health system in Illinois and an assessment of clinical outcomes for patients treated for C. auris infections. Methods This study is a retrospective cohort analysis of patients at 8 hospitals within a single health system located in the Chicago metropolitan area. We included all patients >18 years old who had >1 positive culture for C. auris from any anatomic site during January 1,

Characteristics, Risk Factors, and Survival Analysis of Candida auris Cases: Results of One-Year National Surveillance Data from Oman

“…Regarding antimicrobial susceptibility testing, there are no specific Breakpoints identified for C. auris ; tentative breakpoints developed by CDC are currently in use [ 14 ]. Apart from the study by Kellie Arensman et al showing a low rate of resistance to fluconazole (14%) and amphotericin B (3.6) [ 36 ], many reports detected a high rate of resistance to these antifungal classes. A recent review of C. auris cases from the Middle East showed in vitro antifungal susceptibility testing identified 100% of the strains to be resistant to fluconazole (MIC 32 ≥ 256 mg/L) while having variable resistance to other antifungal agents [ 37 ].…”

Candida auris Bloodstream Infections in Russia

“…There are possibilities to follow recommendations of the Center for disease control and prevention (CDC) for a limited number of agents (amphotericin B, fluconazole and echinocandins) or to use C. albicans (or other Candida spp. ) breakpoints as a substitution for C. auris [ 2 , 4 , 24 , 28 , 29 ]. The latter presents additional uncertainty due to the discrepancy of CLSI and EUCAST breakpoints for C. albicans .…”

Candida auris: Epidemiology, biology, antifungal resistance, and virulence

“…Similar to other invasive Candida infections, invasive C . auris infections are associated with high global mortality rates ranging from 30% to 60% [ 10 , 39 , 40 ].…”