An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital

Alba Ruiz-Gaitán; Ana M Moret; María Tasias-Pitarch; Ana I Aleixandre-López; Héctor Martínez-Morel; Eva Calabuig; Miguel Salavert-Lletí; Paula Ramírez; José L López-Hontangas; Ferry Hagen; Jacques F Meis; Juan Mollar-Maseres; Javier Pemán

doi:10.1111/myc.12781

An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital

Alba Ruiz-Gaitán, Ana M Moret, María Tasias-Pitarch, Ana I Aleixandre-López, Héctor Martínez-Morel, Eva Calabuig, Miguel Salavert-Lletí, Paula Ramírez, José L López-Hontangas, Ferry Hagen, Jacques F Meis, Juan Mollar-Maseres, Javier Pemán

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Abstract

Multidrug-resistant Candida auris has emerged as a cause of insidious hospital outbreaks and complicated infections. We present the analysis of an ongoing C. auris outbreak including the largest published series of C. auris bloodstream infection. All C. auris-positive patients from April-2016 to January-2017 were included. Environmental, clinical and microbiological data were recorded. Definitive isolate identification was performed by ITS-rDNA sequencing, and typing by amplified fragment length polymorphism fingerprinting. One hundred and forty patients were colonised by C. auris during the studied period (68% from surgical intensive care). Although control measures were implemented, we were not able to control the outbreak. Forty-one invasive bloodstream infections (87.8% from surgical intensive care) were included. Clinical management included prompt intravascular catheter removal and antifungal therapy with echinocandins. All isolates were fluconazole- and voriconazole-resistant, but echinocandin- and amphotericin B-susceptible. Thirty-day mortality rate was 41.4%, and severe septic metastasis as spondylodiscitis and endocarditis were observed in 5 patients (12%). C. auris was also recovered from inanimate patient surroundings and medical equipment. Despite antifungal treatment, high mortality and late complication rates were recorded. Molecular typing suggested a clonal outbreak different from those previously published.

Original language	English
Pages (from-to)	498-505
Number of pages	8
Journal	Mycoses
Volume	61
Issue number	7
DOIs	https://doi.org/10.1111/myc.12781
Publication status	Published - Jul 2018

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Ruiz-Gaitán, A., Moret, A. M., Tasias-Pitarch, M., Aleixandre-López, A. I., Martínez-Morel, H., Calabuig, E., Salavert-Lletí, M., Ramírez, P., López-Hontangas, J. L., Hagen, F., Meis, J. F., Mollar-Maseres, J., & Pemán, J. (2018). An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital. Mycoses, 61(7), 498-505. https://doi.org/10.1111/myc.12781

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title = "An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital",

abstract = "Multidrug-resistant Candida auris has emerged as a cause of insidious hospital outbreaks and complicated infections. We present the analysis of an ongoing C. auris outbreak including the largest published series of C. auris bloodstream infection. All C. auris-positive patients from April-2016 to January-2017 were included. Environmental, clinical and microbiological data were recorded. Definitive isolate identification was performed by ITS-rDNA sequencing, and typing by amplified fragment length polymorphism fingerprinting. One hundred and forty patients were colonised by C. auris during the studied period (68% from surgical intensive care). Although control measures were implemented, we were not able to control the outbreak. Forty-one invasive bloodstream infections (87.8% from surgical intensive care) were included. Clinical management included prompt intravascular catheter removal and antifungal therapy with echinocandins. All isolates were fluconazole- and voriconazole-resistant, but echinocandin- and amphotericin B-susceptible. Thirty-day mortality rate was 41.4%, and severe septic metastasis as spondylodiscitis and endocarditis were observed in 5 patients (12%). C. auris was also recovered from inanimate patient surroundings and medical equipment. Despite antifungal treatment, high mortality and late complication rates were recorded. Molecular typing suggested a clonal outbreak different from those previously published.",

author = "Alba Ruiz-Gait{\'a}n and Moret, {Ana M} and Mar{\'i}a Tasias-Pitarch and Aleixandre-L{\'o}pez, {Ana I} and H{\'e}ctor Mart{\'i}nez-Morel and Eva Calabuig and Miguel Salavert-Llet{\'i} and Paula Ram{\'i}rez and L{\'o}pez-Hontangas, {Jos{\'e} L} and Ferry Hagen and Meis, {Jacques F} and Juan Mollar-Maseres and Javier Pem{\'a}n",

note = "{\textcopyright} 2018 Blackwell Verlag GmbH.",

year = "2018",

month = jul,

doi = "10.1111/myc.12781",

language = "English",

volume = "61",

pages = "498--505",

journal = "Mycoses",

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Ruiz-Gaitán, A, Moret, AM, Tasias-Pitarch, M, Aleixandre-López, AI, Martínez-Morel, H, Calabuig, E, Salavert-Lletí, M, Ramírez, P, López-Hontangas, JL, Hagen, F, Meis, JF, Mollar-Maseres, J & Pemán, J 2018, 'An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital', Mycoses, vol. 61, no. 7, pp. 498-505. https://doi.org/10.1111/myc.12781

TY - JOUR

T1 - An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital

AU - Ruiz-Gaitán, Alba

AU - Moret, Ana M

AU - Tasias-Pitarch, María

AU - Aleixandre-López, Ana I

AU - Martínez-Morel, Héctor

AU - Calabuig, Eva

AU - Salavert-Lletí, Miguel

AU - Ramírez, Paula

AU - López-Hontangas, José L

AU - Hagen, Ferry

AU - Meis, Jacques F

AU - Mollar-Maseres, Juan

AU - Pemán, Javier

PY - 2018/7

Y1 - 2018/7

N2 - Multidrug-resistant Candida auris has emerged as a cause of insidious hospital outbreaks and complicated infections. We present the analysis of an ongoing C. auris outbreak including the largest published series of C. auris bloodstream infection. All C. auris-positive patients from April-2016 to January-2017 were included. Environmental, clinical and microbiological data were recorded. Definitive isolate identification was performed by ITS-rDNA sequencing, and typing by amplified fragment length polymorphism fingerprinting. One hundred and forty patients were colonised by C. auris during the studied period (68% from surgical intensive care). Although control measures were implemented, we were not able to control the outbreak. Forty-one invasive bloodstream infections (87.8% from surgical intensive care) were included. Clinical management included prompt intravascular catheter removal and antifungal therapy with echinocandins. All isolates were fluconazole- and voriconazole-resistant, but echinocandin- and amphotericin B-susceptible. Thirty-day mortality rate was 41.4%, and severe septic metastasis as spondylodiscitis and endocarditis were observed in 5 patients (12%). C. auris was also recovered from inanimate patient surroundings and medical equipment. Despite antifungal treatment, high mortality and late complication rates were recorded. Molecular typing suggested a clonal outbreak different from those previously published.

AB - Multidrug-resistant Candida auris has emerged as a cause of insidious hospital outbreaks and complicated infections. We present the analysis of an ongoing C. auris outbreak including the largest published series of C. auris bloodstream infection. All C. auris-positive patients from April-2016 to January-2017 were included. Environmental, clinical and microbiological data were recorded. Definitive isolate identification was performed by ITS-rDNA sequencing, and typing by amplified fragment length polymorphism fingerprinting. One hundred and forty patients were colonised by C. auris during the studied period (68% from surgical intensive care). Although control measures were implemented, we were not able to control the outbreak. Forty-one invasive bloodstream infections (87.8% from surgical intensive care) were included. Clinical management included prompt intravascular catheter removal and antifungal therapy with echinocandins. All isolates were fluconazole- and voriconazole-resistant, but echinocandin- and amphotericin B-susceptible. Thirty-day mortality rate was 41.4%, and severe septic metastasis as spondylodiscitis and endocarditis were observed in 5 patients (12%). C. auris was also recovered from inanimate patient surroundings and medical equipment. Despite antifungal treatment, high mortality and late complication rates were recorded. Molecular typing suggested a clonal outbreak different from those previously published.

U2 - 10.1111/myc.12781

DO - 10.1111/myc.12781

M3 - Article

C2 - 29655180

SN - 0933-7407

VL - 61

SP - 498

EP - 505

JO - Mycoses

JF - Mycoses

IS - 7

ER -

An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital

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