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Candida auris infection at a pediatric burn center: Treatment and infection control measures
Seval Ozen1, Belgin Gulhan1, Sabri Demir2
1Department of Pediatric Infectious Diseases, Ankara Bilkent City Hospital, Ankara, Turkiye.
Objective:
Candida auris (C. auris), a novel species, has been increasingly associated with hospital outbreaks worldwide in recent years. C. auris is regarded as a global health problem due to issues with the identification of C. auris, variable antifungal resistance profiles and the requirement for infection prevention and control (IPC) measures. With this study, we aimed to present our experience with two patients with C. auris fungemia who were referred to the Pediatric Burn Center of our hospital at different timepoints and share the antifungal treatment strategy and IPC management policies implemented in the clinic.
Methods:
C. auris isolates were identified using MALDI-TOF MS (VITEK MS, bioMérieux, France). Antifungal susceptibility tests were performed at the Turkish Public Health Institution (THSK) using the broth microdilution (BMD) method. The BMD was carried out in accordance with the Clinical and Laboratory Standards Institute procedures.
Results:
A patient (3-year-old girl) with C. auris which was identified at an external center and negative fungal screening results was transferred to our pediatric burn center. On the 41st day of her hospitalization, she was diagnosed with catheter-related bloodstream infection (CRBSI) by C. auris. She received antifungal treatment for a total of 52 days, including caspofungin for 12 days, followed by micafungin for 40 days. Three months after the detection of the index case, a second patient (2-year-old girl) was diagnosed with CRBSI by C. auris on the 27th day of hospitalization. This patient received antifungal treatment for a total of 42 days, including 30 days of combination therapy (liposomal amphotericin B and voriconazole). Immediately after the recognition of the index C. auris case, infection prevention and control (IPC) measures were formulated and implemented. IPC measures included strict isolation of the patient infected with C. auris, and screening of all other patients and the environment. C. auris was not detected in any of the patients screened. None of the environmental swabs tested positive for C. auris.
Conclusion:
Collaboration between clinical microbiology laboratories and the IPC committee is essential for making correct and early diagnosis, optimizing the management of precautions and reducing the spread of infection in the hospital.
Insights
This study reports two cases of Candida auris fungemia in a pediatric burn center, detailing treatment strategies and infection control measures. Effective collaboration is key to managing this global health threat.
Area of Science:
- Infectious Diseases
- Medical Mycology
- Hospital Epidemiology
Background:
- Candida auris (C. auris) is a significant global health concern due to identification challenges, variable antifungal resistance, and transmission risks.
- Hospital outbreaks of C. auris are increasing worldwide, necessitating robust infection prevention and control (IPC) strategies.
- Pediatric burn centers are particularly vulnerable to multidrug-resistant fungal infections.
Purpose of the Study:
- To describe the clinical experience with two pediatric patients diagnosed with C. auris fungemia.
- To outline the antifungal treatment regimens employed for C. auris bloodstream infections.
- To detail the IPC measures implemented to control C. auris transmission within a hospital setting.
Main Methods:
- C. auris isolates were identified using MALDI-TOF MS.
- Antifungal susceptibility testing was performed using the broth microdilution (BMD) method.
- IPC measures included patient isolation, environmental screening, and patient surveillance.
Main Results:
- Two pediatric patients developed catheter-related bloodstream infections (CRBSI) caused by C. auris.
- Treatment involved prolonged antifungal therapy, including caspofungin, micafungin, liposomal amphotericin B, and voriconazole.
- Implemented IPC measures successfully prevented further C. auris spread, with no new cases or environmental contamination detected.
Conclusions:
- Effective collaboration between clinical microbiology laboratories and IPC committees is crucial for early diagnosis and management of C. auris infections.
- Prompt implementation of stringent IPC protocols can contain the spread of C. auris in healthcare settings.
- Antifungal treatment strategies for C. auris fungemia require careful consideration of susceptibility profiles and clinical response.
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