Ongoing Challenges with Healthcare-Associated Candida auris Outbreaks in Oman

Abstract

Candida auris has emerged in the past decade as a multi-drug resistant public health threat causing health care outbreaks. Here we report epidemiological, clinical, and microbiological investigations of a C. auris outbreak in a regional Omani hospital between April 2018 and April 2019. The outbreak started in the intensive care areas (intensive care unit (ICU), coronary care unit (CCU), and high dependency unit) but cases were subsequently diagnosed in other medical and surgical units. In addition to the patients' clinical and screening samples, environmental swabs from high touch areas and from the hands of 35 staff were collected. All the positive samples from patients and environmental screening were confirmed using MALDI-TOF, and additional ITS-rDNA sequencing was done for ten clinical and two environmental isolates. There were 32 patients positive for C. auris of which 14 (43.8%) had urinary tract infection, 11 (34.4%) had candidemia, and 7 (21.8%) had asymptomatic skin colonization. The median age was 64 years (14-88) with 17 (53.1%) male and 15 (46.9%) female patients. Prior to diagnosis, 21 (65.6%) had been admitted to the intensive care unit, and 11 (34.4%) had been nursed in medical or surgical wards. The crude mortality rate in our patient's cohort was 53.1. Two swabs collected from a ventilator in two different beds in the ICU were positive for C. auris. None of the health care worker samples were positive. Molecular typing showed that clinical and environmental isolates were genetically similar and all belonged to the South Asian C. auris clade I. Most isolates had non-susceptible fluconazole (100%) and amphotericin B (33%)

Evaluation of Microsatellite Typing, ITS Sequencing, AFLP Fingerprinting, MALDI-TOF MS, and Fourier-Transform Infrared Spectroscopy Analysis of Candida auris

“…A set of 96 C. auris isolates was obtained from the Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands ( n = 37), the Centers for Disease Control and Prevention (CDC, Atlanta, GA, USA; n = 10), and individual researchers ( n = 49). The majority of isolates came from India ( n = 38) [ 2 , 9 , 10 ], followed by 58 isolates from other geographical areas, namely Austria (from a Turkish patient) ( n = 1) [ 40 ], Belgium (from a Kuwaiti patient) ( n = 2) [ 41 ], Japan ( n = 3) [ 42 ], Israel ( n = 9) [ 43 , 44 ], Korea ( n = 3) [ 8 ], Malaysia ( n = 3) [ 45 ], Oman ( n = 13) [ 46 , 47 ], Pakistan ( n = 2), Saudi Arabia ( n = 2) [ 48 ], Spain ( n = 13) [ 49 ], South Africa ( n = 4), Switzerland ( n = 1) [ 50 ], and Venezuela ( n = 2) [ 13 ] ( Supplementary Table S1 ). The isolates were identified by MALDI-TOF MS (Bruker Daltonik) using routine settings [ 27 , 51 ], and the Bruker MBT Compass Library, Revision E (7854 reference entries).…”

A Cluster of Candida auris Blood Stream Infections in a Tertiary Care Hospital in Oman from 2016 to 2019

“…Candida auris is currently one of the most common clinical fungal pathogens, causing nosocomial infections [ 7 ]. Especially ICU patients with medical devices such as central venous catheters (CVC) or urinary catheters, treatment with broad-spectrum antibiotics, long hospital stays, major surgery and immunosuppressive therapy are affected [ 1 , 12 , 13 ]. Because of higher drug-resistance rate, C. auris is more difficult to treat, requires longer hospitalization periods, and results in higher morbidity and mortality than other Candida species [ 14 ].…”

“…In 2017, the first cases of C. auris from Oman were reported [ 15 , 16 ], and in 2019, we reported an outbreak in the city of Sohar [ 12 ]. In this study, we report 23 cases of C. auris fungaemia diagnosed at a tertiary care center in Muscat, Oman.…”

Molecular characterisation and clinical outcomes of Candida auris infection: Single‐centre experience in Saudi Arabia

“…Middle Eastern countries have reported locally acquired cases including in Kuwait, Oman, United Arab Emirates, Iran and Israel 4‐14 . Candida auris poses a challenge in health care settings because it is a multidrug‐resistant pathogen 15,16 and it can cause hospital outbreaks 6,14,17,18 . Furthermore, it has been associated with high mortality rates, 2,14,16,17 with crude mortality between 30% and 70% 16 .…”