Ongoing Challenges with Healthcare-Associated <i>Candida auris</i> Outbreaks in Oman
<i>Candida auris</i> 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 <i>C. auris</i> outbreak in a regional Omani hospital between Ap...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2019-10-01
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| Series: | Journal of Fungi |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2309-608X/5/4/101 |
| _version_ | 1818294790770393088 |
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| author | Amal Al Maani Hema Paul Azza Al-Rashdi Adil Al Wahaibi Amina Al-Jardani Asma M. Ali Al Abri Mariam A. H. AlBalushi Seif Al Abri Mohammed Al Reesi Ali Al Maqbali Nashwa M. Al Kasaby Theun de Groot Jacques F. Meis Abdullah M. S. Al-Hatmi |
| author_facet | Amal Al Maani Hema Paul Azza Al-Rashdi Adil Al Wahaibi Amina Al-Jardani Asma M. Ali Al Abri Mariam A. H. AlBalushi Seif Al Abri Mohammed Al Reesi Ali Al Maqbali Nashwa M. Al Kasaby Theun de Groot Jacques F. Meis Abdullah M. S. Al-Hatmi |
| author_sort | Amal Al Maani |
| collection | DOAJ |
| description | <i>Candida auris</i> 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 <i>C. auris</i> 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 <i>C. auris</i> 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 <i>C. auris</i>. 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 <i>C. auris</i> clade I. Most isolates had non-susceptible fluconazole (100%) and amphotericin B (33%) minimal inhibitory concentrations (MICs), but had low echinocandin and voriconazole MICs. Despite multimodal infection prevention and control measures, new cases continued to appear, challenging all the containment efforts. |
| first_indexed | 2024-12-13T03:37:21Z |
| format | Article |
| id | doaj.art-f9fe9f85bb334d488b3f76bc669eb291 |
| institution | Directory Open Access Journal |
| issn | 2309-608X |
| language | English |
| last_indexed | 2024-12-13T03:37:21Z |
| publishDate | 2019-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj.art-f9fe9f85bb334d488b3f76bc669eb2912022-12-22T00:01:01ZengMDPI AGJournal of Fungi2309-608X2019-10-015410110.3390/jof5040101jof5040101Ongoing Challenges with Healthcare-Associated <i>Candida auris</i> Outbreaks in OmanAmal Al Maani0Hema Paul1Azza Al-Rashdi2Adil Al Wahaibi3Amina Al-Jardani4Asma M. Ali Al Abri5Mariam A. H. AlBalushi6Seif Al Abri7Mohammed Al Reesi8Ali Al Maqbali9Nashwa M. Al Kasaby10Theun de Groot11Jacques F. Meis12Abdullah M. S. Al-Hatmi13Directorate General for Disease Surveillance and Control (DGDSC), Ministry of Health, 393 Muscat, OmanDepartment of Infection Prevention and Control, DGDSC, Ministry of Health, 393 Muscat, OmanCentral Public Health Laboratories, DGDSC, Ministry of Health, 393 Muscat, OmanDirectorate General for Disease Surveillance and Control (DGDSC), Ministry of Health, 393 Muscat, OmanCentral Public Health Laboratories, DGDSC, Ministry of Health, 393 Muscat, OmanInfection Prevention and Control Department, Sohar Hospital, Ministry of Health, 749 Sohar, OmanInfection Prevention and Control Department, Sohar Hospital, Ministry of Health, 749 Sohar, OmanDirectorate General for Disease Surveillance and Control (DGDSC), Ministry of Health, 393 Muscat, OmanPaediatric Infectious Diseases Unit, Sohar Hospital, Ministry of Health, 749 Sohar, OmanDepartment of Diseases Surveillance and Control, Directorate General of Health Services, North Batinah Governorate, Ministry of Health, 749 Sohar, OmanMicrobiology Section, Pathology Department, Sohar Hospital, 749 Sohar, OmanDepartment of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The NetherlandsDepartment of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The NetherlandsCentre of Expertise in Mycology Radboud University Medical Centre/Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands<i>Candida auris</i> 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 <i>C. auris</i> 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 <i>C. auris</i> 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 <i>C. auris</i>. 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 <i>C. auris</i> clade I. Most isolates had non-susceptible fluconazole (100%) and amphotericin B (33%) minimal inhibitory concentrations (MICs), but had low echinocandin and voriconazole MICs. Despite multimodal infection prevention and control measures, new cases continued to appear, challenging all the containment efforts.https://www.mdpi.com/2309-608X/5/4/101<i>candida auris</i>infectionoutbreaksohar hospitaloman |
| spellingShingle | Amal Al Maani Hema Paul Azza Al-Rashdi Adil Al Wahaibi Amina Al-Jardani Asma M. Ali Al Abri Mariam A. H. AlBalushi Seif Al Abri Mohammed Al Reesi Ali Al Maqbali Nashwa M. Al Kasaby Theun de Groot Jacques F. Meis Abdullah M. S. Al-Hatmi Ongoing Challenges with Healthcare-Associated <i>Candida auris</i> Outbreaks in Oman Journal of Fungi <i>candida auris</i> infection outbreak sohar hospital oman |
| title | Ongoing Challenges with Healthcare-Associated <i>Candida auris</i> Outbreaks in Oman |
| title_full | Ongoing Challenges with Healthcare-Associated <i>Candida auris</i> Outbreaks in Oman |
| title_fullStr | Ongoing Challenges with Healthcare-Associated <i>Candida auris</i> Outbreaks in Oman |
| title_full_unstemmed | Ongoing Challenges with Healthcare-Associated <i>Candida auris</i> Outbreaks in Oman |
| title_short | Ongoing Challenges with Healthcare-Associated <i>Candida auris</i> Outbreaks in Oman |
| title_sort | ongoing challenges with healthcare associated i candida auris i outbreaks in oman |
| topic | <i>candida auris</i> infection outbreak sohar hospital oman |
| url | https://www.mdpi.com/2309-608X/5/4/101 |
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