Emergence of multidrug-resistant and opportunistic fungal infections due to Candida auris in intensive care units

Document Type : Original Articles

Authors

1 Department of Microbiology, Subharti Medical College, Swami Vivekanand Subharti NH-58, Delhi-Haridwar Bypass Road, Meerut-250005, Uttar Pradesh, India

2 Department of Microbiology, Subharti Medical College, Meerut, Uttar Pradesh, India

10.22034/cmm.2024.345249.1558

Abstract

Background and Purpose: An increasing number of invasive infections due to multidrug-resistant Candida species have been reported worldwide. Among these Candida species, Candida auris has attracted more attention in recent years due to major outbreaks in healthcare facilities globally and is considered an emerging pathogen. This study was planned to observe the occurrence of C. auris infections in a tertiary care hospital in India.
Materials and Methods: The clinical specimens were inoculated on Sabouraud dextrose agar along with other conventional culture media for aerobic culture based on specimen type. The blood culture was performed by BacT/ALERT 3D automated blood culture system. After preliminary identification, the species-level identification of Candida was performed by the VITEK-2 compact automated system from bioMerieux, France.
Results: Out of a total of 497 Candida isolates, 21.33% were Candida albicans, while 78.67% were non-albicans Candida species. Candida auris comprised 3.22% of all Candida isolates. Among various risk factors, intensive care unit stay was the most common risk factor associated with C. auris infection. The antifungal susceptibility data highlighted the resistance of C. auris against most of the antifungals except echinocandins.
Conclusion: Infections due to C. auris are emerging in hospital environments, especially among individuals having various risk factors. The resistant nature of C. auris further complicates the situation leading to frequent antifungal treatment failure.

Keywords

Main Subjects

References

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  2. Colombo AL, Junior JNA, Guinea J. Emerging multidrug-resistant Candida Curr Opin Infect Dis. 2017;30(6):528-38.
  3. Levy y, Miltgen G, Rousseau A, Lugagne N, Teysseyre L, Traversier N, et al. Case report: Emergence of Candida auris in the Indian Ocean Region. Am J Trop Med Hyg. 2021;104(2):739–43.
  4. Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. Candida auris nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol. 2009;53(1):41-4.
  5. Rudramurthy SM, Chakrabarti A, Paul RA, Sood P, Kaur H, Capoor MR, et al. Candida auris candidaemia in Indian ICUs: analysis of risk factors. J Antimicrob Chemother. 2017;72(6):
    1794-801.
  6. Meena S, Rohilla R, Kaistha N, Singh A, Gupta P. Candida auris emergence in the Himalayan foothills: First case report from Uttarakhand, India. Current Medical Mycology. 2020;6(1):47-50.
  7. Griffith N, Danziger L. Candida auris Urinary Tract Infections and Possible Treatment. Antibiotics (Basel). 2020;9(12):898.
  8. Garcia Rivera MV, Heyl JJ, Oh MC. Candida auris Urinary Tract Infection in a nursing home patient with multicomorbities. Cureus. 2020;12(12):e12322.
  9. Shaukat A, Ansari NA, Wali WA, Karic E, Madhoun IE, Mitwally H, et al. Experience of treating Candida auris cases at a general hospital in the state of Qatar. 2020;23:e01007.
  10. Sathyapalan DT, Antony R, Nampoothiri V, Kumar A, Shashindran N, James J, et al. Evaluating the measures taken to contain a Candida auris outbreak in a tertiary care hospital in South India: an outbreak investigational study. BMC Infectious Diseases. 2021;21(1):425.
  11. Chowdhary A, Tarai B, Singh A, Sharma A. Multidrug-Resistant Candida auris Infections in Critically Ill Coronavirus Disease Patients, India, April–July 2020. Emerging Infectious Diseases. 2020;26(11):2694-6.
  12. Calvo B, Melo AS, Perozo-Mena A, Hernandez M, Francisco EC, Hagen F, et al. First report of Candida auris in America: clinical and microbiological aspects of 18 episodes of candidemia. J Infect. 2016;73(4):369-74.
  13. Morales-Lopez SE, Parra-Giraldo CM, Ceballos-Garzón A, Martínez HP, Rodríguez GJ, Álvarez-Moreno CA, et al. Invasive infections with multidrug-resistant yeast Candida auris, Colombia. Emerg Infect Dis. 2017;23(1):162-4.
  14. Ambaraghassi G, Dufresne PJ, Dufresne SF, Vallières É, Muñoz JF, Cuomo CA, et al. Identification of Candida auris by use of the updated Vitek 2 yeast identification system, version 8.01: a multilaboratory evaluation study. J Clin Microbiol. 2019;57(11):
    e00884-19.
  15. National Center for Emerging and Zoonotic Infectious Diseases. Centers for disease control and prevention. Algorithm to identify Candida auris based on phenotypic laboratory method and initial species identification. 2024.
  16. Centers for disease control and prevention. Antifungal Susceptibility Testing for auris. April 23, 2024.
  17. Thatchanamoorthy N, Devi VR, Chandramathi S, Tay ST. Candida auris: A mini review on epidemiology in healthcare facilities in Asia. J Fungi (Basel). 2022;8(11):1126.
  18. Ortiz-Roa C, Valderrama-Rios MC, Sierra-Umana SF, Rodriguez JY, Muneton-Lopez GA, Solorzano-Ramos CA, et al. Mortality Caused byCandida auris Bloodstream Infections in Comparison with Other Candida Species, a Multicentre Retrospective Cohort. J Fungi (Basel). 2023;9(7):715.
  19. Kaki R. Risk factors and mortality of the newly emergingCandida auris in a university hospital in Saudi Arabia. Mycology. 2023;14(3):256-63.
  20. Prayag PS, Patwardhan S, Panchakshari S, Rajhans PA, Prayag A. The Dominance of Candida auris: A Single-center Experience of 79 Episodes of Candidemia from Western India. Indian J Crit Care Med. 2022;26(5):560–3.
  21. Ashraf AA, Pinto R S, Karnaker VK. Candida auris in a Tertiary Healthcare Setting in South India: A Case Series. Curr Med Mycol. 2023;9(4):33-8.
  22. Sridharan S, Gopalakrishnan R, Nambi PS, Kumar S, Nandini S, Ramasubramanian V. Clinical Profile of Non-neutropenic Patients with Invasive Candidiasis: A Retrospective Study in a Tertiary Care Center. Indian J Crit Care Med. 2021;
    25(3):267–72.
  23. Kathuria S, Singh PK, Sharma C, Prakash A, Masih A, Kumar A, et al. Multidrug-resistant Candida auris misidentified as Candida haemulonii: characterization by matrix assisted laser desorption ionization–time of flight mass spectrometry and DNA sequencing and its antifungal susceptibility profile variability by Vitek 2, CLSI broth microdilution, and Etest method. J Clin Microbiol. 2015;53(6):1823–30.
  24. de Araujo Motta F, Dalla-Costa LM, Dominguez Muro M, Lenzi A, Picharski GL, Burger M. Risk Adjustment for Congenital Heart Surgery Score as a Risk Factor for Candidemia in Children Undergoing Congenital Heart Defect Surgery. Pediatr Infect Dis J. 2016;35(11):1194-8.
  25. Alvarado-Socarras JL, Vargas-Soler JA, Franco-Paredes C, Villegas-Lamus KC, Rojas-Torres JP, Rodriguez-Morales AJ. A Cluster of Neonatal Infections Caused by Candida auris at a Large Referral Center in Colombia. J Pediatric Infect Dis Soc. 2021;10(5):549-55.
  26. Biswal M, Rudramurthy SM, Jain N, Shamanth AS, Sharma D, Jain K, et al. Controlling a possible outbreak of Candida auris infection: lessons learnt from multiple interventions.J Hosp Infect. 2017;97(4):363-70.
  27. Abdolrasouli A, Armstrong-James D, Ryan L, Schelenz S. In vitro efficacy of disinfectants utilised for skin decolonisation and environmental decontamination during a hospital outbreak with Candida auris. 2017;60(11):758-63.
  28. Sikora A, Hashmi MF, Zahra F. Candida auris. StatPearls Publishing. 2024.

 

  1. Ahmad S, Alfouzan W. Candida auris: Epidemiology, diagnosis, pathogenesis, antifungal susceptibility and infection control measures to combat the spread of infections in healthcare facilities. 2021;9(4):807.
  2. Colombo AL, Junior JNA, Guinea J. Emerging multidrug-resistant Candida Curr Opin Infect Dis. 2017;30(6):528-38.
  3. Levy y, Miltgen G, Rousseau A, Lugagne N, Teysseyre L, Traversier N, et al. Case report: Emergence of Candida auris in the Indian Ocean Region. Am J Trop Med Hyg. 2021;104(2):739–43.
  4. Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. Candida auris nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol. 2009;53(1):41-4.
  5. Rudramurthy SM, Chakrabarti A, Paul RA, Sood P, Kaur H, Capoor MR, et al. Candida auris candidaemia in Indian ICUs: analysis of risk factors. J Antimicrob Chemother. 2017;72(6):
    1794-801.
  6. Meena S, Rohilla R, Kaistha N, Singh A, Gupta P. Candida auris emergence in the Himalayan foothills: First case report from Uttarakhand, India. Current Medical Mycology. 2020;6(1):47-50.
  7. Griffith N, Danziger L. Candida auris Urinary Tract Infections and Possible Treatment. Antibiotics (Basel). 2020;9(12):898.
  8. Garcia Rivera MV, Heyl JJ, Oh MC. Candida auris Urinary Tract Infection in a nursing home patient with multicomorbities. Cureus. 2020;12(12):e12322.
  9. Shaukat A, Ansari NA, Wali WA, Karic E, Madhoun IE, Mitwally H, et al. Experience of treating Candida auris cases at a general hospital in the state of Qatar. 2020;23:e01007.
  10. Sathyapalan DT, Antony R, Nampoothiri V, Kumar A, Shashindran N, James J, et al. Evaluating the measures taken to contain a Candida auris outbreak in a tertiary care hospital in South India: an outbreak investigational study. BMC Infectious Diseases. 2021;21(1):425.
  11. Chowdhary A, Tarai B, Singh A, Sharma A. Multidrug-Resistant Candida auris Infections in Critically Ill Coronavirus Disease Patients, India, April–July 2020. Emerging Infectious Diseases. 2020;26(11):2694-6.
  12. Calvo B, Melo AS, Perozo-Mena A, Hernandez M, Francisco EC, Hagen F, et al. First report of Candida auris in America: clinical and microbiological aspects of 18 episodes of candidemia. J Infect. 2016;73(4):369-74.
  13. Morales-Lopez SE, Parra-Giraldo CM, Ceballos-Garzón A, Martínez HP, Rodríguez GJ, Álvarez-Moreno CA, et al. Invasive infections with multidrug-resistant yeast Candida auris, Colombia. Emerg Infect Dis. 2017;23(1):162-4.
  14. Ambaraghassi G, Dufresne PJ, Dufresne SF, Vallières É, Muñoz JF, Cuomo CA, et al. Identification of Candida auris by use of the updated Vitek 2 yeast identification system, version 8.01: a multilaboratory evaluation study. J Clin Microbiol. 2019;57(11):
    e00884-19.
  15. National Center for Emerging and Zoonotic Infectious Diseases. Centers for disease control and prevention. Algorithm to identify Candida auris based on phenotypic laboratory method and initial species identification. 2024.
  16. Centers for disease control and prevention. Antifungal Susceptibility Testing for auris. April 23, 2024.
  17. Thatchanamoorthy N, Devi VR, Chandramathi S, Tay ST. Candida auris: A mini review on epidemiology in healthcare facilities in Asia. J Fungi (Basel). 2022;8(11):1126.
  18. Ortiz-Roa C, Valderrama-Rios MC, Sierra-Umana SF, Rodriguez JY, Muneton-Lopez GA, Solorzano-Ramos CA, et al. Mortality Caused byCandida auris Bloodstream Infections in Comparison with Other Candida Species, a Multicentre Retrospective Cohort. J Fungi (Basel). 2023;9(7):715.
  19. Kaki R. Risk factors and mortality of the newly emergingCandida auris in a university hospital in Saudi Arabia. Mycology. 2023;14(3):256-63.
  20. Prayag PS, Patwardhan S, Panchakshari S, Rajhans PA, Prayag A. The Dominance of Candida auris: A Single-center Experience of 79 Episodes of Candidemia from Western India. Indian J Crit Care Med. 2022;26(5):560–3.
  21. Ashraf AA, Pinto R S, Karnaker VK. Candida auris in a Tertiary Healthcare Setting in South India: A Case Series. Curr Med Mycol. 2023;9(4):33-8.
  22. Sridharan S, Gopalakrishnan R, Nambi PS, Kumar S, Nandini S, Ramasubramanian V. Clinical Profile of Non-neutropenic Patients with Invasive Candidiasis: A Retrospective Study in a Tertiary Care Center. Indian J Crit Care Med. 2021;
    25(3):267–72.
  23. Kathuria S, Singh PK, Sharma C, Prakash A, Masih A, Kumar A, et al. Multidrug-resistant Candida auris misidentified as Candida haemulonii: characterization by matrix assisted laser desorption ionization–time of flight mass spectrometry and DNA sequencing and its antifungal susceptibility profile variability by Vitek 2, CLSI broth microdilution, and Etest method. J Clin Microbiol. 2015;53(6):1823–30.
  24. de Araujo Motta F, Dalla-Costa LM, Dominguez Muro M, Lenzi A, Picharski GL, Burger M. Risk Adjustment for Congenital Heart Surgery Score as a Risk Factor for Candidemia in Children Undergoing Congenital Heart Defect Surgery. Pediatr Infect Dis J. 2016;35(11):1194-8.
  25. Alvarado-Socarras JL, Vargas-Soler JA, Franco-Paredes C, Villegas-Lamus KC, Rojas-Torres JP, Rodriguez-Morales AJ. A Cluster of Neonatal Infections Caused by Candida auris at a Large Referral Center in Colombia. J Pediatric Infect Dis Soc. 2021;10(5):549-55.
  26. Biswal M, Rudramurthy SM, Jain N, Shamanth AS, Sharma D, Jain K, et al. Controlling a possible outbreak of Candida auris infection: lessons learnt from multiple interventions.J Hosp Infect. 2017;97(4):363-70.
  27. Abdolrasouli A, Armstrong-James D, Ryan L, Schelenz S. In vitro efficacy of disinfectants utilised for skin decolonisation and environmental decontamination during a hospital outbreak with Candida auris. 2017;60(11):758-63.
  28. Sikora A, Hashmi MF, Zahra F. Candida auris. StatPearls Publishing. 2024.

 

 

Current Medical Mycology
Volume 10, Continuous
2024
Pages 1-6

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History

  • Receive Date: 10 July 2024
  • Revise Date: 09 October 2024
  • Accept Date: 22 October 2024
  • Publish Date: 01 March 2024

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