Candida auris infections in an intensive care unit: Antifungal resistance, mortality rates and infection control interventions

Abstract

Candida auris spreads rapidly and causes outbreaks worldwide. Strict infection control is critical to control its spread; however, it is challenging and requires a special approach. This study aims to investigate the colonization and infection of C. auris in intensive care units (ICUs), analyses its susceptibility, and mortality rates, and contributes to an effective infection control.An infection control study was planned, and a C. auris infection control bundle and checklist were developed. During the study's pre-intervention, intervention, and post-intervention periods, C. auris candidemia cases and colonized patients were identified. Until the infection control intervention, all the candidemia cases, antifungal resistance, and mortality were investigated retrospectively. Clinical isolates were identified by phenotypic and genotypic characterization using MALDI-TOF MS Biotyper (Bruker Daltonics, Bremen, Germany) and sequencing.During the pre-intervention, intervention, and post-intervention periods, 26 C. auris cases were identified. Pan-resistant C. auris isolates were 3.84%, and the multidrug resistance was 65.38%. With the infection control intervention, the number of colonized patients decreased (pre-intervention 9.61‰, intervention 6.19‰, post-intervention 5.20‰). Candidemia incidence decreased from 4.09 to 2.3‰. No new cases of candidemia were observed at the end of the study.The risk of new cases is elevated in the rooms where multiple C. auris cases have been previously isolated. Mortality rate was high; namely, 76.92% of patients died, and 19.23% of strains were resistant to anidulofungin, one of the most commonly used antifungals. Despite the short implementation period, the infection control bundle and checklist have been demonstrated to be effective in controlling C. auris spread in the ICU.

Keywords: Candida auris; infection control; intensive care unit; mortality; outbreaks; resistance.