Setting a Protocol for Identification and Detecting the Prevalence of Candida auris in Tertiary Egyptian Hospitals Using the CDC Steps

Abstract

BACKGROUND: Candida is considered the most common cause of opportunistic infections in the world. Increased use of antifungal agents may have led to increasing resistance of Candida for antifungals and may be related to therapeutic failures. Recently, a multidrug-resistant Candida auris has immerged causing outbreaks in several countries all over the world. This discovered superbug is widely spread causing a broad range of health care-associated infections. AIM: This study aims to set a protocol for the identification and detection of the prevalence of C. auris in tertiary Egyptian hospitals following the center of disease and control (CDC) methodology. METHODOS: Over almost 2 years, 400 Candida isolates were collected from different wards of Cairo University Hospitals. Identification of species of all isolates was done by germ tube test followed by sub-culturing on chromogenic agar media for confirmation. Candida non-albicans isolates were further subjected to thermotolerance. Isolates that grew in 42°C were further identified by matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry for definite species identification. Antifungal susceptibility using E-test was done for isolates identified by MALDI to detect resistance patterns. RESULTS: Among the 400 isolates, 227 (56.75%) were Candida albicans while 180 (43.25%) were non-albicans Candida. Candida non-albicans was classified by Chromagar as following; 25 (13.8%) were Candida tropicalis, 43 (23.8%) were Candida krusei, and 112 (62.2%) were other Candida spp. (Candida glabrata, Candida kefyr, Candida parapsilosis, and Candida lusitaniae). Using thermotolerance, 10 isolates grew at 42°C suspecting C. auris. MALDI-TOF was used for definite and final identification; five isolates were identified as C. glabrata, four as C. krusei, and one C. kefyr. Antifungal susceptibility testing of the 10 identified isolates revealed total resistance to fluconazole. CONCLUSION: Following the set protocol for identification based on CDC guidelines, C. auris is not prevalent in Egyptian hospitals. Fluconazole resistance is on the surge among candida isolates. Further studies on a bigger scale including larger number of hospitals are recommended.

Epidemiology, Clinical Features and Antifungal Resistance Profile of <i>Candida auris</i> in Africa: Systematic Review

“…[27]- [48]. Three countries (Algeria, Egypt and Nigeria) reported fewer than 10 C. auris cases [44] [45] [46] [47] [48]. In Sudan and Kenya, 26 and 86 C. auris cases were reported respectively [41] [42] [43].…”

Emergence of Candida auris in intensive care units in Algeria

“…The real prevalence of C. auris across the African continent is still unknown due to the limited availability of accurate diagnostic tools. So far, C. auris infection/colonisation has only been reported in five African countries, namely Egypt, 18 Kenya, 19,20 Nigeria, 21 South Africa 33 and Sudan 22 …”

“…29 We previously developed a SCA medium for the selective isolation of C. auris yeasts 13 and a RT-PCR system for the specific and rapid detection of this pathogen directly from clinical and environmental samples. 14 namely Egypt, 18 Kenya, 19,20 Nigeria, 21 South Africa 33 and Sudan. 22 Candida auris infections are among the most reported nosocomial infections worldwide, and there are no accurate criteria to distinguish colonisation from infection in C. auris cases.…”

“…16 Clades I and III are the most widespread, with numerous reported cases and a broad geographic distribution. 17 To date, C. auris is poorly documented in Africa and has only been reported in Egypt, 18 Kenya, 19,20 Nigeria, 21 South Africa 5 and Sudan, 22 with the prevalence of clades I, III and IV. 16,23 In Algeria, C. tropicalis has been the most prevalent isolate from candidemia 24 with no published data on C. auris.…”