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Invasive Candida auris infections in Kuwait hospitals: epidemiology, antifungal treatment and outcome

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Abstract

Purpose

Candida auris is a recently recognized yeast pathogen, which has attracted worldwide attention due to its multidrug-resistant nature and associated high mortality rates. Its persistence in hospital environment and propensity of nosocomial transmission underscores the need of continuous monitoring to prevent outbreaks. Since the first case of C. auris candidemia in May, 2014, we have identified 17 additional invasive cases, which are described here.

Methods

Identity of 17 isolates originating from proven or possible cases of invasive C. auris infection and identified as Candida haemulonii by Vitek 2 yeast identification system was confirmed by PCR-sequencing of rDNA. Information about risk factors, treatment and outcomes were retrospectively retrieved from case files. Antifungal susceptibility testing was performed by Etest.

Results

Thirteen cases of candidemia and 4 cases of other invasive infections were detected in 6 hospitals across Kuwait. Major risk factors included adult patients with cancer, diabetes, gastrointestinal/liver diseases and extended (> 25 days) hospital stay. All isolates were resistant to fluconazole. Additionally, 5 and 4 isolates were also resistant to voriconazole and amphotericin B, respectively. Despite antifungal treatment, 9 of 15 patients died. Most patients (n = 12) were hospitalized in 2 hospitals that are in close proximity, whereas 5 other patients were from 3 hospitals that are situated > 10 km apart.

Conclusions

Occurrence of successive cases of invasive C. auris infections with resulting mortality in nine patients suggests persistence of this multidrug-resistant yeast in major hospitals in Kuwait. Early detection by continuous surveillance and enforcement of infection control measures are recommended.

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Acknowledgements

Authors are thankful to Soumya Varghese, Sandhya Vayalil and Omar Musallam for excellent technical support.

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Authors and Affiliations

  1. Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat, 13110, Kuwait City, Kuwait

    Ziauddin Khan, Suhail Ahmad, Eiman Mokaddas & Leena Joseph

  2. Department of Microbiology, Al-Amiri Hospital, Kuwait City, Kuwait

    Khalifa Benwan

  3. Department of Microbiology, Al-Sabah Hospital, Kuwait City, Kuwait

    Prashant Purohit, Inaam Al-Obaid, Ritu Bafna & Maha Emara

  4. Department of Microbiology, Ibn-Sina Hospital, Kuwait City, Kuwait

    Eiman Mokaddas & Aneesa Ahmed Abdullah

  5. Department of Microbiology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait

    Ziauddin Khan, Suhail Ahmad & Khaled Al-Obaid

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  1. Ziauddin Khan
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Correspondence to Ziauddin Khan.

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Khan, Z., Ahmad, S., Benwan, K. et al. Invasive Candida auris infections in Kuwait hospitals: epidemiology, antifungal treatment and outcome. Infection 46, 641–650 (2018). https://doi.org/10.1007/s15010-018-1164-y

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