Clinical spectrum and factors impacting outcome of Candida auris: a single center study from Pakistan

Abstract

Background An outbreak of Candida auris began globally in 2014 including Pakistan and since then it has emerged as a nosocomial multi-drug resistant pathogen. The aim of this study was to assess the clinical spectrum and outcome of patients, from a single center in Pakistan, in whom C. auris was isolated. Methods A retrospective study was conducted on 92 patients; ≥16 years with at least one culture positive for C. auris, at the Aga Khan University Hospital Karachi, Pakistan from Sept 2014-Mar 2017.Demographics, clinical history, management and outcome were studied. A logistic regression model was used to identify the risk factors for mortality. Results We identified 92 patients with C. auris (193 isolates), of whom 52.2% were males. Mean age was 54.14 ± 20.4 years. Positive cultures were obtained after a median hospital stay of 14 days. Most patients had a history of surgery (57.6%), antibiotic use (95.6%), ICU stay (44.6%), indwelling lines (88.04%) and isolation of another multi-resistant organism (52.2%).Most patients were symptomatic (70.7%). Amongst these, 38 had candidemia while 27 had non-candidemia infections. Sites of infection included central lines (35), urinary tract (19), peritonitis (4), nosocomial ventriculitis (1), empyema (1), fungal keratitis (1) otitis externa (1) and surgical site (1). Fluconazole resistance was 100% while 28.5 and 7.9% were Voriconazole and Amphotericin resistant respectively. Overall crude mortality was 42.4% while 14-day mortality was 31.5%. Both infected and colonized cases shared similar mortality (46.2% vs 33.3%; p -value = 0.25). Among infected cases mortality was high in candidemia compared to non-candidemia (60.5% vs 25.9%) in which deaths related to C. auris were 34.2% vs 22.2% respectively. On multivariate analysis candidemia (AOR 4.2, 95% CI: 1.09–16.49; p-value = 0.037) was associated with greater mortality with source control being the only protective factor for mortality (AOR 0.22, 95% CI: 0.05–0.92; p-value0.038] while ICU stay, rapidity of blood culture clearance, DM, malignancy and MDR co-infection had no impact. Conclusion Patients with C.auris from a single center in Pakistan have a wide clinical spectrum with line associated infection being the predominant site of infection. Candidemia leads to high mortality while source control improves outcome.

Ongoing Challenges with Healthcare-Associated Candida auris Outbreaks in Oman

“…Candida auris can persist on different types of surfaces, including moist, dry, and plastic surfaces, with the potential of survival for up to 14 days [33][34][35][36][37]. The success of environmental decontamination was variable in the literature utilizing mostly materials and methods tested earlier against resistant Gram-positive and Gram-negative pathogens [17,21,38,39]. The use of high-concentration chlorine solutions in combination with hydrogen peroxide vapor or UV light for terminal decontamination has been suggested to be effective in controlling the transmission in some reports [17,19,21,40].…”

“…The success of environmental decontamination was variable in the literature utilizing mostly materials and methods tested earlier against resistant Gram-positive and Gram-negative pathogens [17,21,38,39]. The use of high-concentration chlorine solutions in combination with hydrogen peroxide vapor or UV light for terminal decontamination has been suggested to be effective in controlling the transmission in some reports [17,19,21,40]. The same protocol without UV light was used in our setting twice including when it was used for controlling a MERS-CoV outbreak, but this failed to have impact on the incidence of new C. auris cases.…”

Candida auris Infection and Biofilm Formation: Going Beyond the Surface

“…C. auris infection occurs at a variety of clinical sites, including the bloodstream, wounds, and the urinary tract [6,12,13]. In addition, C. auris colonizes skin, nares, wounds, and urine, as a marker of disease risk [3,6,14].…”

Prevalence and Therapeutic Challenges of Fungal Drug Resistance: Role for Plants in Drug Discovery

“…There was a 318% increase in the number of reported C. auris infections in 2018 compared to rates from 2015-2017 [1]. Multiple studies examining C. auris infections from hospitals in India, Colombia, and New York found that 58-76% of these lead to invasive blood stream infections [2,8,9].…”

“…The high rates of drug resistance, coupled with delays in properly identifying C. auris, and the immunocompromised populations commonly infected by it, are major obstacles in effectively treating C. auris infections. These factors may explain the high mortality rate of 35-60% seen in patients [9,28,29].…”