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266. Clinical Profile and Treatment Outcomes of Candida auris Isolates from a Tertiary Care Hospital in South India

BACKGROUND: Candida auris is an emerging multidrug-resistant fungus that is rapidly spreading worldwide. In publications from India, it has already accounted for >5% of candidemia in a national survey of ICUs and as much as 30% of candidemia at individual hospitals,but data on treatment outcomes...

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Autores principales: Warrier, Anup R, Wilson, Arun, Babu, Rachana, Prakash, Shilpa, Bhargava, Madhav
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810388/
http://dx.doi.org/10.1093/ofid/ofz360.341
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author Warrier, Anup R
Wilson, Arun
Babu, Rachana
Prakash, Shilpa
Bhargava, Madhav
author_facet Warrier, Anup R
Wilson, Arun
Babu, Rachana
Prakash, Shilpa
Bhargava, Madhav
author_sort Warrier, Anup R
collection PubMed
description BACKGROUND: Candida auris is an emerging multidrug-resistant fungus that is rapidly spreading worldwide. In publications from India, it has already accounted for >5% of candidemia in a national survey of ICUs and as much as 30% of candidemia at individual hospitals,but data on treatment outcomes is scarce. This study reviews the various clinical syndromes in our case series, the treatment regimens we opted and their clinical outcomes. METHODS: The present study was a retrospective observational analysis of candida auris isolates obtained from patients admitted in a Aster Medcity, Kochi. Duration of study was 4 months (September 2018 to December 2018). Laboratory confirmation of the candida auris isolates was done as per CDC recommendations for Vitek2. Vitek2 was also used for obtaining the antifungal sensitivity pattern for these isolates. RESULTS: We had 18 cases of Candida auris identified. The most common syndrome was surgical site infections, 9 out of 18 (50%), followed by Catheter-Associated Urinary Tract Infection (CAUTI 5/18; 28%). We had 3 patients with Central Line-Associated Blood Stream Infections (CLABSI) and one patient who had secondary peritonitis. The overall mortality was 28% (5/18)—mostly contributed by the CLABSI. Considering breakpoints from CLSI as well as CDC, all isolates had their minimum inhibitory concentration (MIC) in the sensitive range for Caspofungin. Both Amphotericin b and Voriconazole had MICs in susceptible range for less than 50% of the isolates and almost all isolates were having very high MICs for Fluconazole, highlighting the increased levels of antifungal resistance which has made this Candida species notorious. CONCLUSION: Candida auris is an emerging nosocomial pathogen in India with serious outbreak potential. The anti-fungal susceptibility is indicative of a multidrug-resistant pattern—with favorable MIC to Echinocandin and Voriconazole. Complicated bloodstream infections had high mortality inspite of early Echinocandin use. Of note, 6 patients out of 18, were managed successfully without any anti-fungal use; as they had either mild UTI (fever spikes resolved with catheter removal) or superfical SSI which could be treated with topical wound management. [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68103882019-10-28 266. Clinical Profile and Treatment Outcomes of Candida auris Isolates from a Tertiary Care Hospital in South India Warrier, Anup R Wilson, Arun Babu, Rachana Prakash, Shilpa Bhargava, Madhav Open Forum Infect Dis Abstracts BACKGROUND: Candida auris is an emerging multidrug-resistant fungus that is rapidly spreading worldwide. In publications from India, it has already accounted for >5% of candidemia in a national survey of ICUs and as much as 30% of candidemia at individual hospitals,but data on treatment outcomes is scarce. This study reviews the various clinical syndromes in our case series, the treatment regimens we opted and their clinical outcomes. METHODS: The present study was a retrospective observational analysis of candida auris isolates obtained from patients admitted in a Aster Medcity, Kochi. Duration of study was 4 months (September 2018 to December 2018). Laboratory confirmation of the candida auris isolates was done as per CDC recommendations for Vitek2. Vitek2 was also used for obtaining the antifungal sensitivity pattern for these isolates. RESULTS: We had 18 cases of Candida auris identified. The most common syndrome was surgical site infections, 9 out of 18 (50%), followed by Catheter-Associated Urinary Tract Infection (CAUTI 5/18; 28%). We had 3 patients with Central Line-Associated Blood Stream Infections (CLABSI) and one patient who had secondary peritonitis. The overall mortality was 28% (5/18)—mostly contributed by the CLABSI. Considering breakpoints from CLSI as well as CDC, all isolates had their minimum inhibitory concentration (MIC) in the sensitive range for Caspofungin. Both Amphotericin b and Voriconazole had MICs in susceptible range for less than 50% of the isolates and almost all isolates were having very high MICs for Fluconazole, highlighting the increased levels of antifungal resistance which has made this Candida species notorious. CONCLUSION: Candida auris is an emerging nosocomial pathogen in India with serious outbreak potential. The anti-fungal susceptibility is indicative of a multidrug-resistant pattern—with favorable MIC to Echinocandin and Voriconazole. Complicated bloodstream infections had high mortality inspite of early Echinocandin use. Of note, 6 patients out of 18, were managed successfully without any anti-fungal use; as they had either mild UTI (fever spikes resolved with catheter removal) or superfical SSI which could be treated with topical wound management. [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6810388/ http://dx.doi.org/10.1093/ofid/ofz360.341 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Warrier, Anup R
Wilson, Arun
Babu, Rachana
Prakash, Shilpa
Bhargava, Madhav
266. Clinical Profile and Treatment Outcomes of Candida auris Isolates from a Tertiary Care Hospital in South India
title 266. Clinical Profile and Treatment Outcomes of Candida auris Isolates from a Tertiary Care Hospital in South India
title_full 266. Clinical Profile and Treatment Outcomes of Candida auris Isolates from a Tertiary Care Hospital in South India
title_fullStr 266. Clinical Profile and Treatment Outcomes of Candida auris Isolates from a Tertiary Care Hospital in South India
title_full_unstemmed 266. Clinical Profile and Treatment Outcomes of Candida auris Isolates from a Tertiary Care Hospital in South India
title_short 266. Clinical Profile and Treatment Outcomes of Candida auris Isolates from a Tertiary Care Hospital in South India
title_sort 266. clinical profile and treatment outcomes of candida auris isolates from a tertiary care hospital in south india
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810388/
http://dx.doi.org/10.1093/ofid/ofz360.341
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