Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Central Laboratory Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Mycoses. 2021 Sep;64(9):1062-1072. doi: 10.1111/myc.13320. Epub 2021 Jun 7.
To describe the first outbreak of Candida auris in Brazil, including epidemiological, clinical and microbiological data.
After the first Candida auris-colonised patient was diagnosed in a COVID-19 ICU at a hospital in Salvador, Brazil, a multidisciplinary team conducted a local C. auris prevalence investigation. Screening cultures for C. auris were collected from patients, healthcare workers and inanimate surfaces. Risk factors for C. auris colonisation were evaluated, and the fungemia episodes that occurred after the investigation were also analysed and described. Antifungal susceptibility of the C. auris isolates was determined, and they were genotyped with microsatellite analysis.
Among body swabs collected from 47 patients, eight (n = 8/47, 17%) samples from the axillae were positive for C. auris. Among samples collected from inanimate surfaces, digital thermometers had the highest rate of positive cultures (n = 8/47, 17%). Antifungal susceptibility testing showed MICs of 0.5 to 1 mg/L for AMB, 0.03 to 0.06 mg/L for voriconazole, 2 to 4 mg/L for fluconazole and 0.03 to 0.06 mg/L for anidulafungin. Microsatellite analysis revealed that all C. auris isolates belong to the South Asian clade (Clade I) and had different genotypes. In multivariate analysis, having a colonised digital thermometer was the only independent risk factor associated with C. auris colonisation. Three episodes of C. auris fungemia occurred after the investigation, with 30-day attributable mortality of 33.3%.
Emergence of C. auris in Salvador, Brazil, may be related to local C. auris clade I closely related genotypes. Contaminated axillary monitoring thermometers may facilitate the dissemination of C. auris reinforcing the concept that these reusable devices should be carefully cleaned with an effective disinfectant or replaced by other temperature monitoring methods.
描述巴西首例耳念珠菌（Candida auris）爆发情况，包括流行病学、临床和微生物学数据。
在巴西萨尔瓦多一家医院的 COVID-19 ICU 诊断出首例耳念珠菌定植患者后，一个多学科团队对当地的耳念珠菌流行情况进行了调查。从患者、医护人员和无生命物体表面采集了耳念珠菌筛查培养物。评估了耳念珠菌定植的危险因素，并分析和描述了调查后的真菌血症发作情况。对耳念珠菌分离株的抗真菌药敏性进行了测定，并采用微卫星分析对其进行了基因分型。
在从 47 名患者采集的 47 份体拭子中，有 8 份（n=8/47，17%）腋窝样本为耳念珠菌阳性。在从无生命物体表面采集的样本中，数字体温计的阳性培养率最高（n=8/47，17%）。抗真菌药敏试验显示 AMB 的 MIC 值为 0.5 至 1 mg/L，伏立康唑为 0.03 至 0.06 mg/L，氟康唑为 2 至 4 mg/L，阿尼达氟康唑为 0.03 至 0.06 mg/L。微卫星分析显示，所有耳念珠菌分离株均属于南亚谱系（Clade I），并具有不同的基因型。多变量分析显示，定植的数字体温计是与耳念珠菌定植相关的唯一独立危险因素。调查后发生了 3 例耳念珠菌真菌血症，30 天归因死亡率为 33.3%。
巴西萨尔瓦多出现的耳念珠菌可能与当地亲缘关系密切的 I 型耳念珠菌谱系有关。受污染的腋窝监测体温计可能有助于耳念珠菌的传播，这进一步证实了这些可重复使用的设备应使用有效的消毒剂仔细清洁或更换为其他温度监测方法的概念。
