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Kaki R. Risk factors and mortality of the newly emerging Candida auris in a university hospital in Saudi Arabia. Mycology 2023; 14:256-263. [PMID: 37583454 PMCID: PMC10424598 DOI: 10.1080/21501203.2023.2227218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/14/2023] [Indexed: 08/17/2023] Open
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.
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Affiliation(s)
- Reham Kaki
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Infectious Disease & Infection Control and Environmental Health, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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2
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Mucocutaneous Candida Infections in Immunocompromised Patients. CURRENT DERMATOLOGY REPORTS 2022. [DOI: 10.1007/s13671-022-00356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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3
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Govender NP, Avenant T, Brink A, Chibabhai V, Cleghorn J, du Toit B, Govind C, Lewis E, Lowman W, Mahlangu H, Maslo C, Messina A, Mer M, Pieton K, Seetharam S, Sriruttan C, Swart K, van Schalkwyk E. Federation of Infectious Diseases Societies of Southern Africa guideline: Recommendations for the detection, management and prevention of healthcare-associated Candida auris colonisation and disease in South Africa. S Afr J Infect Dis 2019; 34:163. [PMID: 34485460 PMCID: PMC8377779 DOI: 10.4102/sajid.v34i1.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/13/2019] [Indexed: 11/03/2022] Open
Abstract
Candida auris has been detected at almost 100 South African hospitals, causing large outbreaks in some facilities, and this pathogen now accounts for approximately 1 in 10 cases of candidaemia. The objective of this guideline is to provide updated, evidence-informed recommendations outlining a best-practice approach to prevent, diagnose and manage C. auris disease in public- and private-sector healthcare settings in South Africa. The 18 practical recommendations cover five focus areas: laboratory identification and antifungal susceptibility testing, surveillance and outbreak response, infection prevention and control, clinical management and antifungal stewardship.
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Affiliation(s)
- Nelesh P Govender
- National Institute for Communicable Diseases, Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, Division of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Theunis Avenant
- Kalafong Provincial Tertiary Hospital and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Adrian Brink
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Ampath Laboratories, Cape Town, South Africa
| | - Vindana Chibabhai
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,National Health Laboratory Service, Johannesburg, South Africa.,Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Joy Cleghorn
- Life Healthcare Group, Johannesburg, South Africa
| | | | | | - Elsie Lewis
- Steve Biko Pretoria Academic Hospital, Pretoria, South Africa
| | - Warren Lowman
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,WITS Donald Gordon Medical Centre and Vermaak and Partners Pathologists, Johannesburg, South Africa
| | | | | | - Angeliki Messina
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Netcare Hospitals Limited, Johannesburg, South Africa
| | - Mervyn Mer
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Kim Pieton
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | - Charlotte Sriruttan
- National Institute for Communicable Diseases [Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses], a Division of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karin Swart
- Netcare Hospitals Limited, Johannesburg, South Africa
| | - Erika van Schalkwyk
- National Institute for Communicable Diseases [Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses], a Division of the National Health Laboratory Service, Johannesburg, South Africa
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Hashemi MM, Rovig J, Holden BS, Taylor MF, Weber S, Wilson J, Hilton B, Zaugg AL, Ellis SW, Yost CD, Finnegan PM, Kistler CK, Berkow EL, Deng S, Lockhart SR, Peterson M, Savage PB. Ceragenins are active against drug-resistant Candida auris clinical isolates in planktonic and biofilm forms. J Antimicrob Chemother 2019; 73:1537-1545. [PMID: 29635279 DOI: 10.1093/jac/dky085] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/20/2018] [Indexed: 12/16/2022] Open
Abstract
Background Candida auris has emerged as a serious threat to human health. Of particular concern are the resistance profiles of many clinical isolates, with some being resistant to multiple classes of antifungals. Objectives Measure susceptibilities of C. auris isolates, in planktonic and biofilm forms, to ceragenins (CSAs). Determine the effectiveness of selected ceragenins in gel and cream formulations in eradicating fungal infections in tissue explants. Materials and methods A collection of 100 C. auris isolates available at CDC was screened for susceptibility to a lead ceragenin. A smaller collection was used to characterize antifungal activities of other ceragenins against organisms in planktonic and biofilm forms. Effects of ceragenins on fungal cells and biofilms were observed via microscopy. An ex vivo model of mucosal fungal infection was used to evaluate formulated forms of lead ceragenins. Results Lead ceragenins displayed activities comparable to those of known antifungal agents against C. auris isolates with MICs of 0.5-8 mg/L and minimum fungicidal concentrations (MFCs) of 2-64 mg/L. No cross-resistance with other antifungals was observed. Fungal cell morphology was altered in response to ceragenin treatment. Ceragenins exhibited activity against sessile organisms in biofilms. Gel and cream formulations including 2% CSA-44 or CSA-131 resulted in reductions of over 4 logs against established fungal infections in ex vivo mucosal tissues. Conclusions Ceragenins demonstrated activity against C. auris, suggesting that these compounds warrant further study to determine whether they can be used for topical applications to skin and mucosal tissues for treatment of infections with C. auris and other fungi.
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Affiliation(s)
- Marjan M Hashemi
- Department of Chemistry and Biochemistry, Brigham Young University, C100 BNSN, Provo, UT 84602, USA
| | - John Rovig
- Department of Chemistry and Biochemistry, Brigham Young University, C100 BNSN, Provo, UT 84602, USA
| | - Brett S Holden
- Department of Chemistry and Biochemistry, Brigham Young University, C100 BNSN, Provo, UT 84602, USA
| | - Maddison F Taylor
- Department of Chemistry and Biochemistry, Brigham Young University, C100 BNSN, Provo, UT 84602, USA
| | - Scott Weber
- Department of Chemistry and Biochemistry, Brigham Young University, C100 BNSN, Provo, UT 84602, USA
| | - John Wilson
- Department of Chemistry and Biochemistry, Brigham Young University, C100 BNSN, Provo, UT 84602, USA
| | - Brian Hilton
- Department of Chemistry and Biochemistry, Brigham Young University, C100 BNSN, Provo, UT 84602, USA
| | - Aaron L Zaugg
- Department of Chemistry and Biochemistry, Brigham Young University, C100 BNSN, Provo, UT 84602, USA
| | - Samuel W Ellis
- Department of Chemistry and Biochemistry, Brigham Young University, C100 BNSN, Provo, UT 84602, USA
| | - Connor D Yost
- Department of Chemistry and Biochemistry, Brigham Young University, C100 BNSN, Provo, UT 84602, USA
| | | | | | - Elizabeth L Berkow
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shenglou Deng
- Department of Chemistry and Biochemistry, Brigham Young University, C100 BNSN, Provo, UT 84602, USA
| | - Shawn R Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Paul B Savage
- Department of Chemistry and Biochemistry, Brigham Young University, C100 BNSN, Provo, UT 84602, USA
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Lone SA, Ahmad A. Candida auris-the growing menace to global health. Mycoses 2019; 62:620-637. [PMID: 30773703 DOI: 10.1111/myc.12904] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 02/06/2023]
Abstract
A paradigm shift of candidiasis from Candida albicans to non-albicans Candida species has fundamentally increased with the advent of C. auris. C. auris, despite being a newly emerged multidrug-resistant fungal pathogen, is associated with severe invasive infections and outbreaks with high mortality rates. Initially reported from Japan in 2009, C. auris have now been found in different countries on all the continents except Antarctica. Due to its capability of nosocomial transmission and forming adherent biofilms on clinically important substrates, a high number of related hospital outbreaks have been reported worldwide. As C. auris is a multidrug-resistant pathogen and is prone to misidentification by available conventional methods, it becomes difficult to detect and manage C. auris infection and also limits the therapeutic options against this deadly pathogen. The emergence of multidrug-resistant C. auris advocates and amplifies the vigilance of early diagnosis and appropriate treatment of fungal infections. In this review, we discussed the nine-year-old history of C. auris-its trends in global emergence, epidemiological relatedness, isolation, mortality, associated risk factors, virulence factors, drug resistance and susceptibility testing, diagnostic challenges, microbiological characteristics, therapeutic options and infection prevention and control associated with this pathogen.
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Affiliation(s)
- Shabir A Lone
- Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Aijaz Ahmad
- Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.,Infection Control, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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Clinical spectrum and factors impacting outcome of Candida auris: a single center study from Pakistan. BMC Infect Dis 2019; 19:384. [PMID: 31060514 PMCID: PMC6501321 DOI: 10.1186/s12879-019-3999-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/17/2019] [Indexed: 01/05/2023] Open
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.
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Alfouzan W, Dhar R, Albarrag A, Al-Abdely H. The emerging pathogen Candida auris: A focus on the Middle-Eastern countries. J Infect Public Health 2019; 12:451-459. [PMID: 31000491 DOI: 10.1016/j.jiph.2019.03.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/27/2019] [Accepted: 03/10/2019] [Indexed: 01/18/2023] Open
Abstract
Recent emergence of Candida auris as a multidrug resistant fungal pathogen, associated with difficult-to-control nosocomial transmission and high mortality, raises serious concerns for public health. Since it was first reported from Japan in 2009, C. auris infections have been diagnosed in several countries from all over the world. However, there is a paucity of reported cases from the Middle East. Literature search resulted in finding only six countries (Kuwait, Israel, Oman, KSA, UAE and Iran) reporting C. auris infections in the past three years. All patients were adults with several underlying comorbidities. Majority of the cases presented with bloodstream infection with crude mortality rate of 60%. All isolates were misidentified as C. haemulonii by commercial systems requiring specialized methods for identification. In vitro antifungal susceptibility testing showed 100% strains to be resistant to fluconazole (MIC 32 ≥ 256 mg/L) while variable resistance against other antifungal agents.
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Affiliation(s)
- Wadha Alfouzan
- Microbiology Unit, Department of Laboratories, Farwania Hospital, Kuwait; Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
| | - Rita Dhar
- Microbiology Unit, Department of Laboratories, Farwania Hospital, Kuwait
| | - Ahmed Albarrag
- Department of Pathology, Faculty of Medicine, King Saud University, Saudi Arabia
| | - Hail Al-Abdely
- Section Infectious Diseases, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Osei Sekyere J. Candida auris: A systematic review and meta-analysis of current updates on an emerging multidrug-resistant pathogen. Microbiologyopen 2018; 7:e00578. [PMID: 29345117 PMCID: PMC6079168 DOI: 10.1002/mbo3.578] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/21/2017] [Accepted: 11/27/2017] [Indexed: 11/13/2022] Open
Abstract
From 2009, Candida auris has emerged as a multidrug‐resistant ascomycete yeast pathogen with the capacity for easy transmission between patients and hospitals, as well as persistence on environmental surfaces. Its association with high mortalities, breakthrough and persistent candidaemia, inconsistencies in susceptibility testing results, misidentification by available commercial identification systems and treatment failure, complicates its management and detection. Within the last nine years, C. auris has been increasingly reported from far‐Eastern Asia, the Middle East, Africa, Europe, South and North America with substantial fatalities and misidentification. Herein, I provide a systematic and thorough review of this emerging pathogen. Meta‐analysis showed that at least 742 C. auris isolates have been reported in 16 countries, with most of these being from India (≥243), USA (≥232) and UK (≥103) (p‐value = .0355) within 2013–2017. Most isolates were from males (64.76%) (p‐value = .0329) and blood (67.48%) (p‐value < .0001), with substantial crude mortality (29.75%) (p‐value = .0488). Affected patients presented with other comorbidities: diabetes (≥52), sepsis (≥48), lung diseases (≥39), kidney diseases (≥32) etc. (p‐value < .0001). Resistance to fluconazole (44.29%), amphotericin B (15.46%), voriconazole (12.67%), caspofungin (3.48%) etc. were common (p‐value = .0059). Commonly used diagnostic tools included PCR (30.38%), Bruker MALDI‐TOF MS (14.00%), Vitek 2 YST ID (11.93%), AFLP (11.55%) and WGS (10.04%) (p‐value = .002). Multidrug resistance, high attributable mortality and persistence are associated with C. auris infections. Two novel drugs, SCY‐078 and VT‐1598, are currently in the pipeline. Contact precautions, strict infection control, periodic surveillance and cleaning with chlorine‐based detergents, efficient, faster and cheaper detection tools are necessary for prevention, containment and early diagnosis of C. auris infections.
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Affiliation(s)
- John Osei Sekyere
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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