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Case–Case Comparison of Candida auris Versus Other Candida Species Bloodstream Infections: Results of an Outbreak Investigation in Colombia

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Abstract

Background

Candida auris is an emerging multidrug-resistant yeast that causes outbreaks in healthcare settings around the world. In 2016, clinicians and public health officials identified patients with C. auris bloodstream infections (BSI) in Colombian healthcare facilities. To evaluate potential risk factors and outcomes for these infections, we investigated epidemiologic and clinical features of patients with C. auris and other Candida species BSI.

Methods

We performed a retrospective case-case investigation in four Colombian acute care hospitals, defining a case as Candida spp. isolated from blood culture during January 2015–September 2016. C. auris BSI cases were compared to other Candida species BSI cases. Odds ratio (OR), estimated using logistic regression, was used to assess the association between risk factors and outcomes.

Results

We analyzed 90 patients with BSI, including 40 with C. auris and 50 with other Candida species. All had been admitted to the intensive care unit (ICU). No significant demographic differences existed between the two groups. The following variables were independently associated with C. auris BSI: ≥ 15 days of pre-infection ICU stay (OR: 5.62, CI: 2.04–15.5), evidence of severe sepsis (OR: 3.70, CI 1.19–11.48), and diabetes mellitus (OR 5.69, CI 1.01–31.9).

Conclusion

Patients with C. auris BSI had longer lengths of ICU stay than those with other candidemias, suggesting that infections are acquired during hospitalization. This is different from other Candida infections, which are usually thought to result from autoinfection with host flora.

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Acknowledgements

The authors acknowledge the collaboration of the Public Health Laboratories in Colombia, as well as private laboratories. We also thank the “Unidad de Proteómica y Micosis Humana, Pontificia Universidad Javeriana¨ for providing assistance in the identification of isolates with MALDI TOF. Reina Turcios-Ruiz, Loren Cadena, Snigdha Vallabhaneni, Anastasia P. Litvintseva, Elizabeth L. Berkow, Cary Hilbert, Alex Bandea, Ngoc Le and Colleen Lysen at CDC. We also want to thank Alejandro Guzman, Jairo E Pérez-Franco and Juan M. Correa, Diego H. Caceres would like to acknowledge Oak Ridge Institute for Science and Education (ORISE).

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Author notes

  1. These authors contributed equally to this article: Diego H. Caceres, Sandra M Rivera, Franklin E. Prieto, Brendan R. Jackson

Authors and Affiliations

  1. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA

    Diego H. Caceres, Paige A. Armstrong, Nancy A. Chow, Gordana Derado, Andres Espinosa-Bode, Matthew J. Stuckey, Shawn R. Lockhart, Tom M. Chiller & Brendan R. Jackson

  2. Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands

    Diego H. Caceres

  3. Instituto Nacional de Salud (INS), Bogotá, Colombia

    Sandra M. Rivera, Patricia Escandon, Maria Victoria Ovalle, Jorge Díaz & Franklin E. Prieto

  4. Clínica General del Norte, Barranquilla, Colombia

    Soraya Salcedo

  5. Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia

    Indira Berrio

  6. Hospital general de Medellín, Medellín, Colombia

    Indira Berrio

  7. Hospital Doña Pilar, Cartagena, Colombia

    Carmen Varón

  8. Hospital Militar Central, Bogotá, Colombia

    Adriana Mariño

  9. Clínica los Nogales, Bogotá, Colombia

    Nohora Villalobos

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  1. Diego H. Caceres
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  2. Sandra M. Rivera
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Corresponding author

Correspondence to Diego H. Caceres.

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Caceres, D.H., Rivera, S.M., Armstrong, P.A. et al. Case–Case Comparison of Candida auris Versus Other Candida Species Bloodstream Infections: Results of an Outbreak Investigation in Colombia. Mycopathologia 185, 917–923 (2020). https://doi.org/10.1007/s11046-020-00478-1

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