First Three Reported Cases of Nosocomial Fungemia Caused by Candida auris

Abstract

Candida auris is a newly described species whose clinical significance is not clear. Here, we describe the first three cases of nosocomial fungemia caused by C. auris, which confirms that it is a causative agent of bloodstream infections. All three patients presented persistent fungemia for 10 to 31 days. The isolates obtained from the three patients were misidentified as Candida haemulonii and Rhodotorula glutinis by the Vitek 2 and the API 20C systems, respectively. C. auris was confirmed by sequence analysis of the internal transcribed spacer region and D1/D2 regions of the 26S ribosomal DNA of the rRNA gene. The MIC ranges of amphotericin B (AMB), fluconazole (FLU), itraconazole, and voriconazole were 0.5 to 1, 2 to 128, 0.125 to 2, and 0.06 to 1 g/ml, respectively. All isolates were susceptible to caspofungin (MIC ‫؍‬ 0.06 g/ml) and micafungin (MIC ‫؍‬ 0.03 g/ml). One patient developed breakthrough fungemia while receiving FLU therapy, and two patients who received FLU therapy followed by AMB showed therapeutic failure and fatal outcomes. Our cases show that C. auris fungemia can be persistent, despite FLU or AMB therapy, which emphasizes the importance of accurately identifying this species.

Itraconazole-resistant Candida auris with phospholipase, proteinase and hemolysin activity from a case of vulvovaginitis

“…Few researchers have in fact proved its pathogenic nature by performing histopathological study [11]. Instead, we studied the virulence traits of this isolate to reveal its pathogenic character.…”

“…The increasing isolation of C. auris from various clinical specimens clearly indicates its ability to colonise, invade and cause disease with varying severity. Though a limited number of studies have addressed this isolate, the majority of them have reported this species to be intrinsically resistant to azoles and amphotericin B [11]. C. auris is intrinsically less susceptible to fluconazole with propensity to develop high-level resistance.…”

Reclassification of the Candida haemulonii Complex as Candida haemulonii (C. haemulonii Group I), C. duobushaemulonii sp. nov. (C. haemulonii Group II), and C. haemulonii var. vulnera var. nov.: Three Multiresistant Human Pathogenic Yeasts

“…C. haemulonii, C. haemulonii var. vulnera, C. duobushaemulonii, C. auris, and C. pseudohaemulonii are part of this group of rare clinical yeast that so far cannot be well differentiated by current commercial methods (17,23,30,34). Identification of these species should be based on molecular methods such as PCR, sequencing analyses, and MALDI-TOF MS analyses.…”

“…C. haemulonii and C. pseudohaemulonii were isolated from patients with central venous catheter-related fungemia, whereas the C. auris strains were isolated from the ear canals of inpatients (28). Moreover, the first three cases of bloodstream infection due to C. auris have been described recently (23).…”

Detection of Amphotericin B Resistance in Candida haemulonii and Closely Related Species by Use of the Etest, Vitek-2 Yeast Susceptibility System, and CLSI and EUCAST Broth Microdilution Methods

“…Although sequencing confirmed that the isolates were C. haemulonii group I, Candida pseudohaemulonii, or Candida auris, all were identified as C. haemulonii by the Vitek-2 YST yeast card system (bioMérieux, Marcy l'Étoile, France), and they were genetically closely related compared to other yeasts in the phylogenetic tree (12). Fungemia was the most common clinical presentation (8,10). Some blood isolates of C. haemulonii and C. pseudohaemulonii from fungemic patients exhibited high-level in vitro resistance to AMB and were associated with AMB therapeutic failure (8).…”