Risk factors and mortality of the newly emerging Candida auris in a university hospital in Saudi Arabia

Abstract

Candida auris presents a global health threat. We investigated risk factors and mortality of Candida auris infections in a retrospective study in Saudi Arabia. We included 27 patients ≥14 with invasive Candida auris from 2015–2022, with median age 58, and 66.7% males. All patients had indwelling devices. The most common infection sources were central line-associated bloodstream infection in 17 (63.0%), and urinary tract infections in four (12%). Fever and shock were observed in nine patients (33.3%) each, and 22 (81%) were admitted to the intensive care unit. Common comorbidities were diabetes and heart disease in 13 (48.1%) patients each. The median hospital stay was 78 days, and the median Charlson index was 4. The C. auris cultures were 100% susceptible to voriconazole, caspofungin, and amphotericin, while three were fully susceptible to fluconazole (11.1%). Despite treatment, 18 (66.7%) patients died. In conclusion, invasive C. auris infection had varied presentations. All patients had indwelling devices, and many had lengthy hospital stays. All isolates were susceptible to amphotericin and echinocandins, while few were fully susceptible to fluconazole.

Description of Candida auris Occurrence in a Tertiary Health Institution in Riyadh, Saudi Arabia

“…This could be useful in distinguishing our prevalence from other comparable hospitals. For instance, in a recent Saudi Arabian study [11] where 27 patients with invasive candidemia were studied for their risk factors and mortality, their prevalence was very different from ours as we had a greater number of colonized patients and only one infected patient.…”

“…Since then, clinical cases of C. auris infections have been reported in other countries including South Korea [3], India [4], Pakistan [5], South Africa [6,7], and Canada [8], with a remarkable surge between 2018 and 2021 in the United States [9]. The first Saudi case was reported in 2018 [10] and was later followed by several reports from other parts of the country [11,12]. This fungal species is rapidly spreading worldwide, with several outbreaks [13] reported from five continents in recent years [4].…”

Antifungal Use and Resistance in a Lower–Middle-Income Country: The Case of Lebanon

“…In Tunisia, resistance to fluconazole was observed in 63 % and 16% of C. albicans and C. glabrata isolates from vaginal swab samples of pregnant women, respectively [ 45 ]. Moreover, numerous sporadic cases and outbreaks caused by C. auris have been recently reported in the MENA region, including Lebanon [ 27 , 29 , 30 , 46 , 47 , 48 ]. Other reports on Aspergillus showed differing frequency of azole resistance as follows: 31.5% were resistant in Lebanon [ 24 ], 30.6% were resistant in Iran [ 49 ], 3.3–25% were resistant in Turkey [ 50 , 51 , 52 ], 4.1% were resistant in Tunisia [ 53 ], 2.9% were resistant in Qatar [ 54 ], and 0% were resistant in Kuwait [ 55 ].…”

Adoption and Use of a Risk Assessment Tool for Identifying and Controlling the Spread of Candida Auris among Admitted Patients at a Saudi Arabian Hospital

“…[2] Although some studies have identified several common risk factors and used them to identify potential colorizations, no study has proposed a validated risk assessment tool for C. auris colonization. [9], [10], [11], [12] Rapid identification of potentially colonized patients could help with early isolation and other infection control measures. [2] Therefore, healthcare settings should have adequate capacity in place to detect C. auris cases early and immediately implement control measures, [13] such as alerts to healthcare staff, contact tracing and enhanced infection prevention and control measures, based on local risk assessment.…”