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Candida auris found among Russian ICU patients

July 16 2019

Candida auris is an emerging fungal pathogen that is often associated with outbreaks of nosocomial infections. Antifungal resistance is common and transmission can be hard to control, as standard disinfection procedures are not sufficiently effective for this organism. C. auris is a notifiable infection in the US

Dr Natalia Barantsevich and colleagues describe a series of cases at an ICU in Moscow where C. auris was isolated from trauma patients.

The first C. auris isolate (fluconazole MIC 256 mg/L) they detected was from the urine of a 40-year-old patient in the ICU following a traffic accident. A further 49 cases were identified between Oct 2016 and Dec 2017, in patients who had undergone trauma (IV lines and urinary catheters were present in each case). However, monthly testing of the hospital environment, healthcare workers’ hands and devices did not recover any isolates.

None of the patients received antifungals other than fluconazole, despite fluconazole resistance being widespread (MIC50 of 256 mg/L). This was partly due to this group of patients already having poor prognoses due to head injuries and other infections, but partly also due to Russia lacking current guidelines for managing C. auris. The CDC recommends first line treatment with an echinocandin and advises on infection control measures. Of patients who developed candidaemia, the 30-day all-cause mortality rate was 42.1%.

Identification was carried out using MALDI-ToF (Bruker Biotyper) as traditional methods can result in misidentification (the CDC gives guidance on identifying C. auris). Sanger sequencing was carried out for ITS and the D1-D2 large subunit rDNA, and these were identical to other C. auris strains deposited in NCBI GenBank. In addition the ERG11 gene was sequenced for four isolates, showing a K143R point mutation typical of isolates from India Pakistan (South Asian clade).

Map of Candida auris cases, courtesy of the CDC