Characteristics and Management of Candidaemia Episodes in an Established <i>Candida auris</i> Outbreak
The multi-resistant yeast <i>Candida auris</i> has become a global public health threat because of its ease to persist and spread in clinical environments, especially in intensive care units. One of the most severe manifestations of invasive candidiasis is candidaemia, whose epidemiology...
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MDPI AG
2020-08-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/9/9/558 |
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| author | Juan V. Mulet Bayona Nuria Tormo Palop Carme Salvador García Paz Herrero Rodríguez Vicente Abril López de Medrano Carolina Ferrer Gómez Concepción Gimeno Cardona |
| author_facet | Juan V. Mulet Bayona Nuria Tormo Palop Carme Salvador García Paz Herrero Rodríguez Vicente Abril López de Medrano Carolina Ferrer Gómez Concepción Gimeno Cardona |
| author_sort | Juan V. Mulet Bayona |
| collection | DOAJ |
| description | The multi-resistant yeast <i>Candida auris</i> has become a global public health threat because of its ease to persist and spread in clinical environments, especially in intensive care units. One of the most severe manifestations of invasive candidiasis is candidaemia, whose epidemiology has evolved to more resistant non-<i>albicans</i><i>Candida</i> species, such as <i>C. auris</i>. It is crucial to establish infection control policies in order to control an outbreak due to nosocomial pathogens, including the implementation of screening colonisation studies. We describe here our experience in managing a <i>C. auris</i> outbreak lasting more than two and a half years which, despite our efforts in establishing control measures and surveillance, is still ongoing. A total of 287 colonised patients and 47 blood stream infections (candidaemia) have been detected to date. The epidemiology of those patients with candidaemia and the susceptibility of <i>C. auris</i> isolates are also reported. Thirty-five patients with candidaemia (74.5%) were also previously colonised. Forty-three patients (91.5%) were hospitalised (61.7%) or had been hospitalised (29.8%) in the ICU before developing candidaemia. Antifungal therapy for candidaemia consisted of echinocandins in monotherapy or in combination with amphotericin B or isavuconazole. The most common underlying disease was abdominal surgery (29.8%). The thirty-day mortality rate was 23.4% and two cases of endophtalmitis due to <i>C. auris</i> were found. All isolates were resistant to fluconazole and susceptible to echinocandins and amphotericin B. One isolate became resistant to echinocandins two months after the first isolate. Although there are no established clinical breakpoints, minimum inhibitory concentrations for isavuconazole were low (≤ 1 μg/mL). |
| first_indexed | 2024-03-10T16:42:33Z |
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| id | doaj.art-1215824b650e4caa9b9d6b7f69cc4921 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T16:42:33Z |
| publishDate | 2020-08-01 |
| publisher | MDPI AG |
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| series | Antibiotics |
| spelling | doaj.art-1215824b650e4caa9b9d6b7f69cc49212023-11-20T11:53:11ZengMDPI AGAntibiotics2079-63822020-08-019955810.3390/antibiotics9090558Characteristics and Management of Candidaemia Episodes in an Established <i>Candida auris</i> OutbreakJuan V. Mulet Bayona0Nuria Tormo Palop1Carme Salvador García2Paz Herrero Rodríguez3Vicente Abril López de Medrano4Carolina Ferrer Gómez5Concepción Gimeno Cardona6Microbiology Department, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, SpainMicrobiology Department, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, SpainMicrobiology Department, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, SpainInfectious Diseases Department, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, SpainInfectious Diseases Department, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, SpainAnestesiology and Reanimation Department, Consorcio Hospital General Universitario de Valencia, 46014 Valencia SpainMicrobiology Department, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, SpainThe multi-resistant yeast <i>Candida auris</i> has become a global public health threat because of its ease to persist and spread in clinical environments, especially in intensive care units. One of the most severe manifestations of invasive candidiasis is candidaemia, whose epidemiology has evolved to more resistant non-<i>albicans</i><i>Candida</i> species, such as <i>C. auris</i>. It is crucial to establish infection control policies in order to control an outbreak due to nosocomial pathogens, including the implementation of screening colonisation studies. We describe here our experience in managing a <i>C. auris</i> outbreak lasting more than two and a half years which, despite our efforts in establishing control measures and surveillance, is still ongoing. A total of 287 colonised patients and 47 blood stream infections (candidaemia) have been detected to date. The epidemiology of those patients with candidaemia and the susceptibility of <i>C. auris</i> isolates are also reported. Thirty-five patients with candidaemia (74.5%) were also previously colonised. Forty-three patients (91.5%) were hospitalised (61.7%) or had been hospitalised (29.8%) in the ICU before developing candidaemia. Antifungal therapy for candidaemia consisted of echinocandins in monotherapy or in combination with amphotericin B or isavuconazole. The most common underlying disease was abdominal surgery (29.8%). The thirty-day mortality rate was 23.4% and two cases of endophtalmitis due to <i>C. auris</i> were found. All isolates were resistant to fluconazole and susceptible to echinocandins and amphotericin B. One isolate became resistant to echinocandins two months after the first isolate. Although there are no established clinical breakpoints, minimum inhibitory concentrations for isavuconazole were low (≤ 1 μg/mL).https://www.mdpi.com/2079-6382/9/9/558<i>Candida auris</i>candidaemiafungiyeastoutbreakmultidrug-resistant |
| spellingShingle | Juan V. Mulet Bayona Nuria Tormo Palop Carme Salvador García Paz Herrero Rodríguez Vicente Abril López de Medrano Carolina Ferrer Gómez Concepción Gimeno Cardona Characteristics and Management of Candidaemia Episodes in an Established <i>Candida auris</i> Outbreak Antibiotics <i>Candida auris</i> candidaemia fungi yeast outbreak multidrug-resistant |
| title | Characteristics and Management of Candidaemia Episodes in an Established <i>Candida auris</i> Outbreak |
| title_full | Characteristics and Management of Candidaemia Episodes in an Established <i>Candida auris</i> Outbreak |
| title_fullStr | Characteristics and Management of Candidaemia Episodes in an Established <i>Candida auris</i> Outbreak |
| title_full_unstemmed | Characteristics and Management of Candidaemia Episodes in an Established <i>Candida auris</i> Outbreak |
| title_short | Characteristics and Management of Candidaemia Episodes in an Established <i>Candida auris</i> Outbreak |
| title_sort | characteristics and management of candidaemia episodes in an established i candida auris i outbreak |
| topic | <i>Candida auris</i> candidaemia fungi yeast outbreak multidrug-resistant |
| url | https://www.mdpi.com/2079-6382/9/9/558 |
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