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P198 Persistent Fungemia with Candida auris in a patient with enterocutaneous fistula

POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM:   OBJECTIVE: Candida auris (C. auris) is a major emerging threat to the healthcare sector in view of the difficulty in early identification by standard methods, multidrug resistance, and ease of spread in healthcare settings. Here, we report...

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Autor principal: Gohel, Swati
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9509731/
http://dx.doi.org/10.1093/mmy/myac072.P198
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author Gohel, Swati
author_facet Gohel, Swati
author_sort Gohel, Swati
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description POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM:   OBJECTIVE: Candida auris (C. auris) is a major emerging threat to the healthcare sector in view of the difficulty in early identification by standard methods, multidrug resistance, and ease of spread in healthcare settings. Here, we report a case of persistent C. auris fungemia (>2 months) in a patient with enterocutaneous fistula. METHODS: A 57-year-old man without any comorbidities underwent surgery for diverticular perforation which was complicated by intra-abdominal abscesses, anastomotic leak, and multidrug-resistant bacteremia requiring higher antibiotics, total parenteral nutrition, and prolonged ICU stay. Patient was admitted to our center with sepsis and blood culture grew C. auris. Patient was managed with injection of caspofungin (in the absence of sensitivity breakpoints). Patient continued to grow C. auris in the blood so flucytosine was added as a part of combination antifungal therapy. On dual antifungal therapy for 28 days there was a transient clearance of fungemia. Work up for endocarditis, intrabdominal collection, and endophthalmitis were negative. But Patient was continued on total parenteral nutrition via central line in view of enterocutaneous fistula. Patient developed a recurrence of fungemia after 4 days of stopping antifungal treatment. Patient was started on injection of mycafugin and voriconazole (in view of on treatment resistance to flucytosine), on which cultures turned sterile and patient improved. Plan was made to give total 6 weeks of parenteral combination antifungal therapy. RESULTS: C. auris management complexities stem from multiple factors. The above case emphasizes the urgent need for C. auris specific minimum inhibitory concentration breakpoints and standard guidelines for treatment. Currently, treatment is based on the Center for Disease Control's proposed breakpoints (extrapolated from other Candida spp.). Upfront combination antifungal treatment might be the answer till further studies. CONCLUSION: Management of invasive C. auris infection presents a major therapeutic challenge to clinicians and a major threat to healthcare sector even after timely identification.
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spelling pubmed-95097312022-09-26 P198 Persistent Fungemia with Candida auris in a patient with enterocutaneous fistula Gohel, Swati Med Mycol Oral Presentations POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM:   OBJECTIVE: Candida auris (C. auris) is a major emerging threat to the healthcare sector in view of the difficulty in early identification by standard methods, multidrug resistance, and ease of spread in healthcare settings. Here, we report a case of persistent C. auris fungemia (>2 months) in a patient with enterocutaneous fistula. METHODS: A 57-year-old man without any comorbidities underwent surgery for diverticular perforation which was complicated by intra-abdominal abscesses, anastomotic leak, and multidrug-resistant bacteremia requiring higher antibiotics, total parenteral nutrition, and prolonged ICU stay. Patient was admitted to our center with sepsis and blood culture grew C. auris. Patient was managed with injection of caspofungin (in the absence of sensitivity breakpoints). Patient continued to grow C. auris in the blood so flucytosine was added as a part of combination antifungal therapy. On dual antifungal therapy for 28 days there was a transient clearance of fungemia. Work up for endocarditis, intrabdominal collection, and endophthalmitis were negative. But Patient was continued on total parenteral nutrition via central line in view of enterocutaneous fistula. Patient developed a recurrence of fungemia after 4 days of stopping antifungal treatment. Patient was started on injection of mycafugin and voriconazole (in view of on treatment resistance to flucytosine), on which cultures turned sterile and patient improved. Plan was made to give total 6 weeks of parenteral combination antifungal therapy. RESULTS: C. auris management complexities stem from multiple factors. The above case emphasizes the urgent need for C. auris specific minimum inhibitory concentration breakpoints and standard guidelines for treatment. Currently, treatment is based on the Center for Disease Control's proposed breakpoints (extrapolated from other Candida spp.). Upfront combination antifungal treatment might be the answer till further studies. CONCLUSION: Management of invasive C. auris infection presents a major therapeutic challenge to clinicians and a major threat to healthcare sector even after timely identification. Oxford University Press 2022-09-20 /pmc/articles/PMC9509731/ http://dx.doi.org/10.1093/mmy/myac072.P198 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. https://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 (https://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 Oral Presentations
Gohel, Swati
P198 Persistent Fungemia with Candida auris in a patient with enterocutaneous fistula
title P198 Persistent Fungemia with Candida auris in a patient with enterocutaneous fistula
title_full P198 Persistent Fungemia with Candida auris in a patient with enterocutaneous fistula
title_fullStr P198 Persistent Fungemia with Candida auris in a patient with enterocutaneous fistula
title_full_unstemmed P198 Persistent Fungemia with Candida auris in a patient with enterocutaneous fistula
title_short P198 Persistent Fungemia with Candida auris in a patient with enterocutaneous fistula
title_sort p198 persistent fungemia with candida auris in a patient with enterocutaneous fistula
topic Oral Presentations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9509731/
http://dx.doi.org/10.1093/mmy/myac072.P198
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