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

Results

We evaluated records from 8 hospitals from the period of January 1, 2008, through April 30, 2019, for C. auris isolates. Cultures were obtained as part of routine clinical practice. A total of 28 patients from 5 hospitals had ≥1 positive culture for C. auris during the study period. We included 28 C. auris isolates in this study (the first isolate from our health system was collected in May 2018). Members of the cohort had a median age of 70 years (interquartile range 6278 years), and most (20 [71%]) patients were men. Most (26 [93%]) patients were admitted from a skilled nursing facility; 1 patient was transferred from another hospital, and 1 was admitted from the community. Nine (75%) patients required chronic mechanical ventilation, and 6 (21%) were receiving hemodialysis through a central line. Most isolates were cultured from blood (12 [43%]) or urine (10 [36%]). The median time from admission to collection of the first culture positive for C. auris was 0.14 days (interquartile range 00.88 days). The average hospital stay for inpatients was 12 days. Thirteen patients (46%) were admitted to an ICU; the average ICU stay was 3 days.

MICs for the 28 C. auris isolates (Table 1) showed that 4 (14%) were resistant to fluconazole, 1 (3.6%) was resistant to amphotericin B, and 1 (3.6%) was resistant to echinocandins, according to tentative C. auris breakpoints published by CDC.[22] One isolate was resistant to fluconazole, amphotericin B, and echinocandins. This isolate was from a patient who was considered to be colonized with C. auris in the urine and did not receive antifungal therapy.

Twelve patients (43%) were treated as inpatients for C. auris infections (Table 2). Of those patients who were not treated with antifungal therapy, 2 were evaluated in the emergency department and were discharged back to their skilled nursing facility in stable condition before their blood cultures results were available, 3 patients died before culture results were available, and 11 were considered to be colonized with C. auris. Of those patients who were treated for C. auris infections, most were found to have a central line–associated bloodstream infection (CLABSI) (7 [59%]), whereas others were treated for catheter-associated urinary tract infection (2 [17%]), skin and skin structure infection (2 [17%]), and other bloodstream infection (BSI) (1 [8%]). All patients who were treated for C. auris infections were under the care of a physician specialized in infectious diseases.

Patients were empirically treated with micafungin (11 [92%]) or fluconazole (1 [8%]). Of those patients empirically treated with micafungin, most were being treated for CLABSI (7 [64%]), followed by catheter-associated urinary tract infection (2 [18%]) and skin and skin structure infection (2 [18%]). For definitive treatment, patients received micafungin (9 [75%]), fluconazole (2 [17%]), or itraconazole (1 [8%]). Of those patients who received an azole as definitive treatment, all were being treated for BSIs. Treatment duration ranged from 5 to 26 days (mean 14 days). The only adverse event noted was an increase in aspartate aminotransferase from 25 to 91 U/L in 1 patient being treated with fluconazole. Fluconazole was continued, and the patient was discharged on fluconazole to complete their treatment course.

Ten (83%) patients met criteria for clinical success. No patients were found to have C. auris recurrence or infection-related readmission within 30 days of first positive culture. Two (17%) patients died within 30 days of first positive culture; both were being treated for CLABSIs.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....