Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat, 13110, Kuwait City, Kuwait.
Department of Microbiology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.
Infection. 2018 Oct;46(5):641-650. doi: 10.1007/s15010-018-1164-y. Epub 2018 Jun 14.
Candida auris is a recently recognized yeast pathogen, which has attracted worldwide attention due to its multidrug-resistant nature and associated high mortality rates. Its persistence in hospital environment and propensity of nosocomial transmission underscores the need of continuous monitoring to prevent outbreaks. Since the first case of C. auris candidemia in May, 2014, we have identified 17 additional invasive cases, which are described here.
Identity of 17 isolates originating from proven or possible cases of invasive C. auris infection and identified as Candida haemulonii by Vitek 2 yeast identification system was confirmed by PCR-sequencing of rDNA. Information about risk factors, treatment and outcomes were retrospectively retrieved from case files. Antifungal susceptibility testing was performed by Etest.
Thirteen cases of candidemia and 4 cases of other invasive infections were detected in 6 hospitals across Kuwait. Major risk factors included adult patients with cancer, diabetes, gastrointestinal/liver diseases and extended (> 25 days) hospital stay. All isolates were resistant to fluconazole. Additionally, 5 and 4 isolates were also resistant to voriconazole and amphotericin B, respectively. Despite antifungal treatment, 9 of 15 patients died. Most patients (n = 12) were hospitalized in 2 hospitals that are in close proximity, whereas 5 other patients were from 3 hospitals that are situated > 10 km apart.
Occurrence of successive cases of invasive C. auris infections with resulting mortality in nine patients suggests persistence of this multidrug-resistant yeast in major hospitals in Kuwait. Early detection by continuous surveillance and enforcement of infection control measures are recommended.
耳念珠菌是一种最近被识别的酵母病原体，由于其多药耐药性和相关的高死亡率，已引起全球关注。它在医院环境中的持续存在和医院内传播的倾向强调了需要持续监测以防止爆发。自 2014 年 5 月首例耳念珠菌菌血症病例以来，我们已经确定了另外 17 例侵袭性病例，现将其描述如下。
通过 rDNA 的 PCR 测序，确认了源自确诊或疑似侵袭性耳念珠菌感染的 17 株分离株的身份，这些分离株最初被 Vitek 2 酵母鉴定系统鉴定为海氏假丝酵母。从病例档案中回顾性检索了有关危险因素、治疗和结局的信息。通过 Etest 进行抗真菌药敏试验。
在科威特的 6 家医院共发现 13 例菌血症和 4 例其他侵袭性感染病例。主要危险因素包括患有癌症、糖尿病、胃肠道/肝脏疾病和住院时间延长（>25 天）的成年患者。所有分离株均对氟康唑耐药。此外，5 株和 4 株分离株分别对伏立康唑和两性霉素 B 耐药。尽管进行了抗真菌治疗，但 15 例患者中有 9 例死亡。大多数患者（n=12）在两家距离较近的医院住院，而另外 5 例患者则来自距离较远（>10 公里）的 3 家医院。
在科威特的主要医院中，连续发生侵袭性耳念珠菌感染病例并导致 9 例患者死亡，这表明这种多药耐药酵母的持续存在。建议通过持续监测和执行感染控制措施来早期发现。
