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. 2019 Sep;25(9):1698-1707.
doi: 10.3201/eid2509.190040.

Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016-20171

Erika van Schalkwyk, Ruth S Mpembe, Juno Thomas, Liliwe Shuping, Husna Ismail, Warren Lowman, Alan S Karstaedt, Vindana Chibabhai, Jeannette Wadula, Theunis Avenant, Angeliki Messina, Chetna N Govind, Krishnee Moodley, Halima Dawood, Praksha Ramjathan, Nelesh P Govender; GERMS-SA
Collaborators

Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016-20171

Erika van Schalkwyk et al. Emerg Infect Dis. 2019 Sep.

Abstract

Candida auris is an invasive healthcare-associated fungal pathogen. Cases of candidemia, defined as illness in patients with Candida cultured from blood, were detected through national laboratory-based surveillance in South Africa during 2016-2017. We identified viable isolates by using mass spectrometry and sequencing. Among 6,669 cases (5,876 with species identification) from 269 hospitals, 794 (14%) were caused by C. auris. The incidence risk for all candidemia at 133 hospitals was 83.8 (95% CI 81.2-86.4) cases/100,000 admissions. Prior systemic antifungal drug therapy was associated with a 40% increased adjusted odds of C. auris fungemia compared with bloodstream infection caused by other Candida species (adjusted odds ratio 1.4 [95% CI 0.8-2.3]). The crude in-hospital case-fatality ratio did not differ between Candida species and was 45% for C. auris candidemia, compared with 43% for non-C. auris candidemia. C. auris has caused a major epidemiologic shift in candidemia in South Africa.

Keywords: Candida; Candida auris; South Africa; antifungal drug resistance; antimicrobial resistance; candidemia; fungi; multidrug resistance; mycoses.

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Figures

Figure 1
Figure 1
Flowchart showing numbers of candidemia cases detected by national surveillance and Candida species identified, South Africa, 2016–2017.
Figure 2
Figure 2
Age distribution of case-patients with candidemia caused by Candida auris compared with other Candida species, South Africa, 2016–2017. A) C. auris patient median age was 54 years (interquartile range 34–67 years); B) other Candida species patient median age was 27 years (interquartile range 0–57 years).
Figure 3
Figure 3
Location and number of 741 Candida auris candidemia cases at 79 hospitals, including 7 hospitals with neonatal cases, South Africa, 2016–2017. Location data were missing for 53 cases.
Figure 4
Figure 4
Cases of Candida auris candidemia (N = 557), by epidemiologic week, Gauteng Province, South Africa, 2016–2017. Date of blood culture collection was missing for 123 cases.
See this image and copyright information in PMC

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