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Published on: December 28, 2017
First three reported cases of nosocomial fungemia caused by Candida auris
Wee Gyo Lee1, Jong Hee Shin, Young Uh
1Department of Laboratory Medicine, Ajou University School of Medicine, Suwon, South Korea.
Abstract:
Candida auris is a newly described species whose clinical significance is not clear. Here, we describe the first three cases of nosocomial fungemia caused by C. auris, which confirms that it is a causative agent of bloodstream infections. All three patients presented persistent fungemia for 10 to 31 days. The isolates obtained from the three patients were misidentified as Candida haemulonii and Rhodotorula glutinis by the Vitek 2 and the API 20C systems, respectively. C. auris was confirmed by sequence analysis of the internal transcribed spacer region and D1/D2 regions of the 26S ribosomal DNA of the rRNA gene. The MIC ranges of amphotericin B (AMB), fluconazole (FLU), itraconazole, and voriconazole were 0.5 to 1, 2 to 128, 0.125 to 2, and 0.06 to 1 μg/ml, respectively. All isolates were susceptible to caspofungin (MIC = 0.06 μg/ml) and micafungin (MIC = 0.03 μg/ml). One patient developed breakthrough fungemia while receiving FLU therapy, and two patients who received FLU therapy followed by AMB showed therapeutic failure and fatal outcomes. Our cases show that C. auris fungemia can be persistent, despite FLU or AMB therapy, which emphasizes the importance of accurately identifying this species.
Insights
Newly identified Candida auris causes persistent nosocomial fungemia, often misidentified by standard tests. Antifungal treatments like fluconazole and amphotericin B showed limited success, highlighting the need for accurate Candida auris identification.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Candida auris is an emerging fungal pathogen with unclear clinical significance.
- Nosocomial infections are a growing concern in healthcare settings.
Observation:
- Three cases of persistent fungemia (10-31 days) caused by Candida auris in hospitalized patients are described.
- Isolates were initially misidentified as Candida haemulonii or Rhodotorula glutinis by automated systems (Vitek 2, API 20C).
- Accurate identification of Candida auris was confirmed through rRNA gene sequence analysis (ITS and D1/D2 regions).
Findings:
- Candida auris demonstrated variable susceptibility to antifungal agents: susceptible to echinocandins (caspofungin, micafungin), but with high Minimum Inhibitory Concentrations (MICs) for fluconazole (2-128 μg/ml).
- One patient experienced breakthrough fungemia during fluconazole therapy.
- Two patients treated with fluconazole followed by amphotericin B (AMB) experienced therapeutic failure and fatal outcomes.
Implications:
- Accurate identification of Candida auris is crucial for effective clinical management.
- Persistent fungemia and treatment failures underscore the challenges in managing Candida auris infections.
- The emergence of Candida auris highlights the need for improved diagnostic methods and antifungal stewardship.
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