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

Methods

This study is a retrospective cohort analysis of patients at 8 hospitals within a single health system located in the Chicago metropolitan area. We included all patients ≥18 years old who had ≥1 positive culture for C. auris from any anatomic site during January 1, 2008–April 30, 2019; we excluded pregnant patients, prisoners, and patients <18 years of age. If a patient had multiple positive cultures for C. auris, we included only the first positive culture per hospital encounter. Patients who died before culture result were not included in clinical success evaluation. The study received a non–human subjects research determination from the Advocate Aurora Health Institutional Review Board.

The microbiology laboratory for this system primarily uses matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (Vitek MS, bioMérieux, https://www.biomerieux.com) for organism identification. Because our database does not include C. auris, for isolates not identified by our MALDI-TOF mass spectrometry system, we used Vitek 2 version 8.01 (bioMérieux), which we have been using since December 2017. We sent isolates identified as C. haemulonii, C. duobushaemulonii, and Candida spp. not identified by Vitek 2 to the Illinois Department of Public Health for additional testing using MALDI-TOF mass spectrometry or genomic sequencing to rule out misidentification of C. auris. During June 2018–April 2019, we sent all isolates identified as C. auris to the Illinois Department of Public Health, which forwarded them to CDC for whole-genome sequencing. We performed antifungal susceptibility testing with colorimetric microdilution by using Sensititer YeastOne YO9 (TREK Diagnostic Systems, https://www.trekds.com). Because no C. auris susceptibility breakpoints have been established, we used tentative breakpoints published by CDC for interpretation in this study.[22]

We performed manual chart review for all patients. We evaluated patient charts for demographic information, infection source, culture source and susceptibilities, empiric and definitive therapy, length of hospital and ICU stay, clinical success, and reports of adverse events associated with treatment for C. auris infection. We defined clinical success as the absence of 30-day all-cause mortality, 30-day recurrence of the same organism, and 30-day infection-related readmission. We identified adverse drug events associated with antifungal therapy by reviewing patient laboratory results and progress notes from healthcare providers.

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