Clinical Outcomes of Patients Treated for Candida auris Infections in a Multisite Health System, Illinois, USA

Kellie Arensman; Jessica L. Miller; Anthony Chiang; Nathan Mai; Joseph Levato; Erik LaChance; Morgan Anderson; Maya Beganovic; Jennifer Dela Pena

Disclosures

Emerging Infectious Diseases. 2020;26(5):876-880. 

In This Article

Abstract and Introduction

Abstract

Candida auris is an emerging fungal pathogen that is typically resistant to fluconazole and is known to cause healthcare-associated outbreaks. We retrospectively reviewed 28 patients who had ≥1 positive culture for C. auris within a multisite health system in Illinois, USA, during May 2018–April 2019. Twelve of these patients were treated as inpatients for C. auris infections; 10 (83%) met criteria for clinical success, defined as absence of all-cause mortality, C. auris recurrence, and infection-related readmission at 30 days from the first positive culture. The other 2 patients (17%) died within 30 days. Most patients (92%) were empirically treated with micafungin. Four (14%) of 28 total isolates were resistant to fluconazole, 1 (3.6%) was resistant to amphotericin B, and 1 (3.6%) was resistant to echinocandins. Our findings describe low rates of antifungal resistance and favorable clinical outcomes for most C. auris patients.

Introduction

Candida auris is an emerging, multidrug-resistant, healthcare-associated fungal pathogen that was first reported in Japan in 2009 and has now been isolated on 6 continents.[1–9]C. auris has been identified as the causative pathogen in various invasive fungal infections, including bloodstream infections,[2,4] and is associated with outbreaks across healthcare settings.[6,10] Risk factors for C. auris infection are similar to other Candida infections including prolonged hospitalization, abdominal surgery, diabetes mellitus, intensive care unit (ICU) admission, use of central venous and urinary catheters, immunocompromising conditions, chronic kidney disease, and exposure to broad-spectrum antibiotic and antifungal agents.[10–13] Investigations in the Chicago, Illinois, USA, area have found a high prevalence of C. auris colonization at ventilator-capable skilled nursing facilities[14] and have shown higher rates of C. auris colonization among patients who are mechanically ventilated, have a gastrostomy tube, or have a urinary catheter.[15] Reported mortality rates attributable to invasive C. auris infection range from 30% to 59% globally[13,16] and from 22% to 57% in the United States.[8,10,17]

C. auris isolates are often resistant to fluconazole and have variable susceptibility to other antifungal agents.[13,16] The Centers for Disease Control and Prevention (CDC) currently recommends echinocandins as empiric therapy for suspected or confirmed C. auris infections.[18] However, recent reports have indicated reduced susceptibilities to echinocandins and suggest that resistance might be inducible under antifungal pressure.[8,16]

Previous reports of C. auris infections and outbreaks have largely focused on epidemiologic information, and data on treatment strategies and clinical outcomes are limited.[6,8,10,16–21] We report microbiologic data for C. auris isolates from a multisite health system in Illinois and an assessment of clinical outcomes for patients treated for C. auris infections.

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