Disease profile and outcomes of patients with candida auris infections, compared to other candida species, at a tertiary South African Hospital
Date
2020
Authors
Parak, Amirah
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Abstract
Introduction
Multidrug resistant Candida auris is a novel and emerging threat worldwide. It has been
identified in Africa, however, there is not enough data available comparing C. auris to other
Candida species found in Africa.
Objective
To compare the clinical and laboratory features, risk factors, treatment and outcome of C. auris
to the most virulent Candida species (Candida albicans) and a well-known azole resistant
Candida species (Candida glabrata). Method
Retrospective, cross-sectional, analysis of all patients with a positive culture for C. auris , from
1 January 2015 to 31 August 2018, at a tertiary South African Hospital. An equal number of
patients with C. albicans and C. glabrata were matched for comparison. Results
Forty-five cases of C. auris infection were identified. The median age was 32 years (IQR 26-
46) with 71.1% (n=32/45) being male. Median duration of hospital stay for C. auris was 64
days (IQR 39-88) and median time from admission to diagnosis was 35 days (IQR 21-53), both
of which were significant compared to C. albicans and C. glabrata (p<0.001). Indwelling
devices, previous antibiotic exposure and multiple surgical procedures were found to be
significant risk factors. All C. auris isolates were healthcare associated with 80% (n=36/45)
acquired in ICU. ICU admission was found to be a significant risk factor. There were no C.
auris isolates resistant to amphotericin B or micafungin. Despite isolates having a low
amphotericin B MIC, patients treated with amphotericin B alone, had a higher mortality
(73.33%, n=11/15) than patients treated with an echinocandin (54.55%, n=6/11). The 30 day
all-cause in-patient mortality was 42% (n=19/45) for C. auris, 36% (n=16/45) for C. albicans
and 53% (n=24/45) for C. glabrata. Conclusion
C. auris is an emerging multi drug resistant threat in South Africa. Improved access to
echinocandins in the public sector is needed for the treatment of C. auris infections. In addition, implementation of improved infection prevention and control strategies are imperative to
prevent this multi-drug resistant pathogen from becoming endemic in South Africa.
Description
A research report submitted n fulfilment of the requirements for the degree of Master of Medicine to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, 2019