Candida auris Bloodstream Infections in Russia

Abstract

Candida auris—a fungus (yeast) that can cause hospital outbreaks was first recognized in 2009. The authors report data on 38 cases of C. auris bloodstream infections in multidisciplinary hospitals situated in two distantly located regions of Russia, considering predisposing factors, antifungal susceptibility of isolates, treatment, and outcomes. Interhospital transfers of patients and labor migration contributed to the spread of C. auris. The South Asian lineage of the studied strains was indicated by K143R substitution in ERG11 gene and phylogenetic analysis of internal transcribed spacer and D1-D2 domain. All isolates from C. auris candidemia cases were susceptible to echinocandins. High-level resistance to fluconazole and resistance to amphotericin B were present in the majority of strains. The overall all-cause mortality rate in C. auris bloodstream infections was 55.3% and the 30-day all-cause mortality rate 39.5%. The attributable mortality was 0%. Eradication of C. auris from blood was associated with the favourable outcomes in patients. It was achieved irrespective of whether antifungal preparations within or outside the susceptibility range were administered. Further international surveillance and studies providing consensus guidelines for the management of C. auris infections are needed.

Molecular Epidemiology of Candida Auris Outbreak in a Major Secondary-Care Hospital in Kuwait

“…C. auris has previously been isolated with increasing frequency from Kuwait [ 14 , 45 ] and other Middle Eastern countries [ 22 ], and outbreaks have also been reported recently from two other (Oman and Saudi Arabia) nearby countries [ 21 , 40 , 41 ]. These reports together with our study and various outbreaks reported recently from other geographical locations [ 3 , 6 , 21 , 30 , 33 , 36 , 37 , 38 , 39 , 40 ] strongly support the emerging role of C. auris as a major cause of invasive infections and outbreaks in health care facilities worldwide that have been difficult to control. C. auris has presumably assumed this role due to several unique characteristics.…”

“…Although in the beginning only sporadic cases of invasive infections due to C. auris were detected soon after its recognition as a bloodstream pathogen, nosocomial outbreaks are now being reported with increasing frequency and involving larger patient cohorts [ 10 , 11 , 28 , 31 ]. C. auris mini/major outbreaks have been reported from the United Kingdom [ 32 , 33 ], United States of America [ 34 , 35 ], India [ 12 , 16 , 25 ], Spain [ 6 , 30 , 36 ], South Africa [ 13 ], Colombia [ 37 ], Kenya [ 38 ], Russia [ 39 ], Saudi Arabia [ 40 ] and Oman [ 21 , 41 ]. Here we describe molecular epidemiology of a nosocomial outbreak which started in the high dependency unit (HDU) of a secondary-care hospital (Farwaniya Hospital) in Kuwait with genetically identical clinical and environmental C. auris isolates.…”

Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal Susceptibility, and Infection Control Measures to Combat the Spread of Infections in Healthcare Facilities

“…Studies have shown that once C. auris is introduced into a healthcare facility, it spreads rapidly among susceptible patients [ 40 , 41 ]. Thus far, C. auris outbreaks have been reported from the United States of America [ 42 , 43 , 44 , 45 ], Canada [ 46 ], Mexico [ 47 ], the United Kingdom [ 48 , 49 ], Spain [ 50 , 51 ], India [ 40 , 52 ], Pakistan [ 53 ], Russia [ 54 ], Saudi Arabia [ 55 ], Oman [ 56 , 57 ], Kuwait [ 58 ], Kenya [ 59 ], South Africa [ 60 ], and Colombia [ 61 ]. Studies describing single/multiple invasive infections and outbreaks in different countries or geographical locations in the last several years have been extensively reviewed, only some of which are cited here [ 29 , 30 , 31 , 32 , 38 ].…”

“…Although C. auris , in addition to fungemia, has also been implicated to cause ventriculitis, pericarditis, complicated pleural effusions and intra-abdominal infections, osteomyelitis, malignant otitis/otomastoiditis, meningitis and vulvovaginitis, its role in respiratory, urinary and skin and soft tissue infections remains uncertain [ 30 , 33 , 34 , 43 , 48 , 50 , 60 , 74 , 89 , 139 , 167 , 168 ]. Due to its multidrug-resistant nature and extraordinary ability to spread rapidly in healthcare facilities causing outbreaks with associated high mortality rates [ 30 , 42 , 43 , 44 , 45 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], the detection of even a single case of C. auris should trigger an epidemiological investigation and the implementation of infection control measures and contact precautions to prevent further transmission [ 77 , 78 , 141 ]. This requires the capacity of hospital microbiology laboratory to efficiently and correctly identify C. auris and, following the detection of positive cases, the institution of robust infection control measures which include alerting treating infectious disease specialists and notification to institutional authorities for setting up outbreak management teams.…”

Candida auris: A Quick Review on Identification, Current Treatments, and Challenges

“…C. auris isolates of patients with candidemia in Russia were susceptible to echinocandins, whereas the high-level of resistance against Flu and AmB was seen in the majority of isolates. More investigation regarding surveillance might be helpful to achieve proper guidelines for the management of candidemia [ 71 ].…”