Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 7;7(1):31.
doi: 10.3390/jof7010031.

Characteristics, Risk Factors, and Survival Analysis of Candida auris Cases: Results of One-Year National Surveillance Data from Oman

Azza Al-Rashdi  1 , Amal Al-Maani  2 , Adil Al-Wahaibi  2 , Abdullah Alqayoudhi  2 , Amina Al-Jardani  1 , Seif Al-Abri  2
Affiliations

Characteristics, Risk Factors, and Survival Analysis of Candida auris Cases: Results of One-Year National Surveillance Data from Oman

Azza Al-Rashdi et al. J Fungi (Basel). .

Abstract

Background: Candida auris (C. auris) is an emerging healthcare-associated pathogen resulting in significant morbidity and mortality. The aim of this study is to report data from the national C. auris surveillance system for 2019 and conduct a survival analysis of the reported cohort.

Methods: a retrospective analysis was conducted for all C. auris cases reported nationally to the Oman Antimicrobial Surveillance System (OMASS) in 2019, and isolates were sent to the Central Public Health Laboratories (CPHL). Clinical and demographic data were obtained through the E-Surveillance reporting system and the Electronic System (NEHR Al-Shifa) at CPHL. Statistical analysis was done using Kaplan-Meier analysis and Cox proportional hazard models.

Results: One hundred and twenty-nine isolates of C. auris were grown from 108 inpatients; 87% were isolated from clinical samples, of which blood was the most common (38.9%). Forty (37%) were ≥65 years of age, 72 (66.7%) were males, and 85 (78.7%) were Omani nationals. Of the total isolates, 43.5% were considered as colonization; 56.5% were considered infection, of which 61.8% of them were candidemia. At least one risk factor was present in 98.1% of patients. The mean time from admission to infection was 1.7 months (SD = 2.8), and the mean length of hospital stay was 3.5 months (SD = 4). Totals of 94.8% and 96.1% of the isolates were non-susceptible to fluconazole and amphotericin, respectively. The variables found to be significantly associated with longer survival post C. auris diagnosis (p < 0.05) were age < 65 years, absence of comorbidities, length of stay < 3 months, colonization, and absence of candidemia. The infection fatality rate was 52.5%.

Conclusion: Including C. auris in an ongoing antimicrobial surveillance program provides important data for the comprehensive management of this growing public health threat. The current study shows health care outbreaks of C. auris are ongoing, with 52.5% infection fatality, although our isolates remained sensitive to Echinocandins in vitro.

Keywords: C. auris; candida; fatality rate; resistance; risk factors; survival.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
C. auris isolates by week over a 1 year period from (A) hospital A, (B) hospital B, (C) hospital C, and (Total) in all 7 hospitals. Numbers in the columns represent number of C.auris isolates per that week.
Figure 2
Figure 2
Kaplan–Meier survival analyses of age, sex, nationality, length of stay, presence of comorbidities, hospital where patients were admitted, candidemia, and colonization vs. infection.
Figure 3
Figure 3
Multivariate Cox proportional hazard model for survival post diagnosis by age, sex, nationality, length of stay, presence of comorbidities, hospital where patients were admitted, candidemia, and colonization vs. infection. Column 3 represent the hazard ratio (95% confidence interval), * statistically significant, p value < 0.05.
See this image and copyright information in PMC

References

    1. Satoh K., Makimura K., Hasumi Y., Nishiyama Y., Uchida K., Yamaguchi H. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol. Immunol. 2009;53:41–44. doi: 10.1111/j.1348-0421.2008.00083.x. - DOI - PubMed
    1. Du H., Bing J., Hu T., Ennis C.L., Nobile C.J., Huang G. Candida auris: Epidemiology, biology, antifungal resistance, and virulence. PLoS Pathog. 2020;16:e1008921. doi: 10.1371/journal.ppat.1008921. - DOI - PMC - PubMed
    1. Candida auris: Information for Laboratorians and Health Professionals. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention. [(accessed on 6 November 2020)];2019 Available online: https://www.cdc.gov/fungal/candida-auris/health-professionals.html.
    1. Hori Y., Shibuya K. Role of FKS Gene in the Susceptibility of Pathogenic Fungi to Echinocandins. Med. Mycol. J. 2018;59:E31–E40. doi: 10.3314/mmj.18.004. - DOI - PubMed
    1. Chowdhary A., Prakash A., Sharma C., Kordalewska M., Kumar A., Sarma S., Tarai B., Singh A., Upadhyaya G., Upadhyay S., et al. A multicentre study of antifungal susceptibility patterns among 350 Candida auris isolates (2009–17) in India: Role of the ERG11 and FKS1 genes in azole and echinocandin resistance. J. Antimicrob. Chemother. 2018;73:891–899. doi: 10.1093/jac/dkx480. - DOI - PubMed

LinkOut - more resources