LB13. Candida auris in NYC: A Health System’s Experience Treating the Emerging Drug-Resistant Yeast

BACKGROUND: Candida auris is emerging multidrug-resistant yeast that can cause serious infections with published mortality rates as high as 60%. It was first recognized in 2009 and has been reported in over a dozen countries. The current United States outbreak was identified in 2016 with New York City (NYC) as the epicenter. The aim of this evaluation was to describe the clinical infections and outcomes with C. auris in a large health system in NYC. METHODS: Cases were identified from clinical specimens collected December 2015–June 2018 from the Mount Sinai Hospital Clinical Microbiology Laboratory, the central laboratory for the Mount Sinai Health System, which encompasses seven hospitals across NYC. All C. auris isolates were confirmed by the New York State Department of Health Wadsworth Center. Medical charts were reviewed. A case was included if C. auris grew from a sterile body site, an antifungal treatment was initiated or the patient expired before the yeast was identified on Gram stain. RESULTS: Twenty-nine possible cases were identified with 23 meeting the case definition. These cases included 19 bloodstream infections (BSI), two intra-abdominal abscesses, one skin soft tissue infection, and one otitis externa. Using the MIC breakpoints recommended by the Centers for Disease Control and Prevention, 100% of isolates tested were susceptible to caspofungin, 29% were susceptible to amphotericin B, and 17% were susceptible to fluconazole. Nineteen patients received antifungal treatment, 13 with caspofungin monotherapy and four with sequential therapy of caspofungin followed by an azole (three with fluconazole, one with posaconazole). Fifteen (65%) patients expired within 90 days of the positive culture. Fourteen of the deaths were in candidemic patients, despite that eight (57%) of these patients had documented microbiologic clearance after appropriate therapy. The 90-day mortality rate was 74% for BSI. CONCLUSIONS: This case series is the largest reported in the United States. Candidemia was the most common site of infection and had a very high 90-day mortality rate, despite sterilization of the blood. These findings highlight the significant morbidity and mortality associated with C. auris and the need to focus efforts on rapid diagnostics and infection prevention. DISCLOSURES: All authors: No reported disclosures.