Detection, Screening, and Antifungal Susceptibility of the Current Threat Candida auris: A Tertiary Hospital Experience

INTRODUCTION: Candida auris is currently reported as a global threat. In this study, we aimed to describe antifungal susceptibility, experiences regarding the detection of C. auris in clinical and environmental samples, and infection control measures.
METHODS: Patients infected or colonized with C. auris and all clinical and environmental screening samples between October 2022 and June 2023 were included. Data on demographics, underlying diseases, length of hospital/intensive care unit (ICU) stay, presence of bacterial/fungal co-infection, history of broad-spectrum antibiotic/antifungal use, outcomes, and antifungal susceptibility results were investigated retrospectively. Screening of contact patients and environmental samples was managed according to the instructions prepared by the infection control committee.
RESULTS: C. auris was isolated in six patients, four with candidemia and two with colonization. Two of the patients with candidemia were hospitalized in the ICU and two in the internal medicine service. All had at least one comorbid disease, pro-longed hospitalization, and a history of broad-spectrum antibiotic use. The crude mortality rate was 50%. Increased minimal inhibitory concentrations (MIC) values for fluconazole and 50% resistance to amphotericin B were detected. No resistance to voriconazole, micafungin, or caspofungin was observed. Two patients with colonization did not develop invasive infections during hospitalization. There was no growth in any of the contact-patient screenings. Growth was detected in one of the environmental samples. As a result of the precautions taken, there was no growth in subsequent environmental cultures.
DISCUSSION AND CONCLUSION: C. auris continues to be an important agent of candidemia with high mortality. Although high MIC values were found for fluconazole and amphotericin B, no echinocandin resistance was observed. C. auris infection and colonization can be controlled with effective infection control measures and contact screening. Clinicians and microbiology specialists in every health-care institution must be prepared for the possible isolation of C. auris to contribute to the reduction of spread and mortality through rapid diagnosis and timely treatment.