An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital.

Multidrug-resistant Candida auris has emerged as a cause of insidious hospital outbreaks and complicated infections. We present the analysis of an ongoing C. auris outbreak including the largest published series of C. auris bloodstream infection. All C. auris-positive patients from April-2016 to January-2017 were included. Environmental, clinical and microbiological data were recorded. Definitive isolate identification was performed by ITS-rDNA sequencing, and typing by amplified fragment length polymorphism fingerprinting. One hundred and forty patients were colonised by C. auris during the studied period (68% from surgical intensive care). Although control measures were implemented, we were not able to control the outbreak. Forty-one invasive bloodstream infections (87.8% from surgical intensive care) were included. Clinical management included prompt intravascular catheter removal and antifungal therapy with echinocandins. All isolates were fluconazole- and voriconazole-resistant, but echinocandin- and amphotericin B-susceptible. Thirty-day mortality rate was 41.4%, and severe septic metastasis as spondylodiscitis and endocarditis were observed in 5 patients (12%). C. auris was also recovered from inanimate patient surroundings and medical equipment. Despite antifungal treatment, high mortality and late complication rates were recorded. Molecular typing suggested a clonal outbreak different from those previously published.

Detection and treatment of Candida auris in an outbreak situation: risk factors for developing colonization and candidemia by this new species in critically ill patients.

BACKGROUND: Candida auris is an emerging, multidrug-resistant yeast causing hospital outbreaks. This study describes the first 24 months of the ongoing C. auris outbreak in our hospital and analyzes predisposing factors to C. auris candidemia/colonization. RESEARCH DESIGN AND METHODS: A 12-month prospective, case-controlled study was performed including a total of 228 patients (114 colonized/candidemia and 114 controls). Data from the first 79 candidemia episodes and 738 environmental samples were also analyzed. Definitive C. auris identification was performed by ITS sequencing. Antifungal susceptibility was carried out by EUCAST methodology. RESULTS: Polytrauma (32%), cardiovascular disease (25%), and cancer (17%) were the most common underlying condition in colonized/candidemia patients. Indwelling CVC (odds ratio {OR}, 13.48), parenteral nutrition (OR, 3.49), and mechanical ventilation (OR, 2.43) remained significant predictors of C. auris colonization/candidemia. C. auris was most often isolated on sphygmomanometer cuffs (25%) patient tables (10.2%), keyboards (10.2%), and infusion pumps (8.2%). All isolates were fully resistant to fluconazole (MICs >64 mg/L) and had significantly reduced susceptibility to voriconazole (GM, 1.8 mg/L). CONCLUSIONS: Predictor conditions to C. auris colonization/candidemia are similar to other Candida species. C. auris colonizes multiple patient's environment surfaces. All isolates are resistant to fluconazole and had significant reduced susceptibility to voriconazole.

Nosocomial fungemia by Candida auris: First four reported cases in continental Europe.

BACKGROUND: Candida auris is an emerging multidrug-resistant yeast that can cause invasive infections and is associated with high mortality. It is typically resistant to fluconazole and voriconazole and, some cases, also to echinocandins and amphotericin B. This species, phylogenetically related to Candida haemulonii, is frequently misidentified by commercial identification techniques in clinical laboratories; therefore, the real prevalence of C. auris infections may be underestimated. AIMS: To describe the clinical and microbiological features of the first four cases of C. auris fungemia episodes observed in the European continent. METHODS: The four patients were hospitalized in the adult surgical intensive care unit. A total of 8 isolates (two per patient) from blood and catheter tip were analyzed. RESULTS: All isolates were misidentified as Saccharomyces cerevisiae by AuxaColor 2, and as Candida sake by API ID20C. VITEK MS technology misidentified one isolate as Candida lusitaniae, another as C. haemulonii and could not identify the other six. C. auris identification was confirmed by ITS rDNA sequencing. All isolates were fluconazole (MIC >256mg/l) and voriconazole (MIC 2mg/l) resistant and susceptible to posaconazole, itraconazole, echinocandins and amphotericin B. CONCLUSIONS: C. auris should be regarded as an emerging pathogen, which requires molecular methods for definitive identification. Our isolates were highly resistant to fluconazole and resistant to voriconazole, but susceptible to the other antifungals tested, which emphasizes the importance of accurately identifying this species to avoid therapeutic failures.

Autoantibodies in Argentine women with recurrent pregnancy loss.

PROBLEM: To determine the presence or absence of subclinical autoimmunity in Caucasian Argentine healthy women with first trimester recurrent pregnancy loss (RPL), the sera of 118 healthy women with a history of three or more consecutive abortions and 125 fertile control women without abortions and two children were analyzed for the presence of autoantibodies: immunoglobulin (Ig)G and IgM anticardiolipin, antinuclear (ANA), antismooth muscle (ASMA), antimitocondrial (AMA), antiliver-kidney-microsomal fraction (LKM), antigastric parietal cells (GPC), antineutrophil cytoplasmatic (ANCA) and antibodies antigliadin type IgA and IgG and IgA antitransglutaminase related with celiac disease (CD). METHOD OF STUDY: ANA, ASMA, AMA, anti-LKM, antibodies to GPC and ANCA were determined by indirect immunofluorescence (IFI) and anticardiolipin, antigliadina and antitransglutaminase antibodies were measured by enzyme-linked immunosorbent assays (ELISA). RESULTS: There was no significant difference between controls and patients with ANA, ASMA, AMA, LKM, ANCA and GPC. The prevalence of anticardiolipin antibodies in RPL was significantly higher than controls (P < 0,01) and the prevalence of positive antibodies for antigliadina type IgA and IgG and IgA antitransglutaminase in RPL was significantly higher than controls (P < 0.04). CONCLUSION: We show that Caucasian Argentine women with RPL showed significantly higher incidence of anticardiolipin antibodies than normal controls and finally we recommended the screening of IgA and IgG antigliadina and IgA antitransglutaminase antibodies in pregnancy, because of the high prevalence of subclinical CD in RPL and the chance of reversibility through consumption of a gluten free diet.

Diagnóstico serológico de la enfermedad de Chagas: utilidad de un enzimoinmunoensayo con antígenos recombinantes en la resolución de muestras con resultados discordantes / Serodiagnosis of Chaga's disease: utility of an enzyme immunoassay with recombinant antigen on samples with inconclusive results

La enfermedad de Chagas es una antropozoonosis causada por un parásito flagelado, el Trypanosoma cruzi. Para la detección de anticuerpos contra el parásito se aconseja la utilización de al menos 2 pruebas serológicas que utilicen antígenos diferentes. En el caso de que una de éstas dé resultado positivo se aconseja incluir una tercera prueba considerándose como inmunodiagnóstico positivo aquella muestra que presente al menos 2 de las 3 reacciones positivas. Debido a este algoritmo diagnóstico surgen muestras con resultados discordantes entre diferentes técnicas serológicas. El objetivo del presente trabajo es evaluar la utilidad de un enzimoinmunoensayo con antígenos recombinantes (ELISArec) en la resolución de muestras con resultados discordantes. Se utilizaron 2 grupos de muestras: grupo 1, muestras con inmunodiagnóstico positivo (enzimoinmunoensayo (ELISA-), hemoaglutinación (HAI+) e inmunofluorescencia (IFI+) y (ELISA+ HAI-IFI+), y grupo 2, muestras con inmunodiagnóstico negativo (ELISA+ HAI-IFI-) y (ELISA-HAI+IFI-). La utilización del ELISArec. mostró resultados concordantes con el resultado final de las muestras del grupo 2 (91,6 por ciento negativas), sin embargo sólo el 16,7 por ciento de las muestras del grupo 1 resultaron positivas con el ELISArec. La falta de coincidencia con el resultado final de las muestras informadas inicialmente como positivas sugiere que la complejidad antigénica del parásito y sus mecanismos de evasión de la respuesta inmune hacen que no exista todavía un método de referencia para arribar al diagnóstico serológico de la enfermedad de Chagas