Volume 19, Number 10—October 2013
Dispatch
New Clonal Strain of Candida auris, Delhi, India
, Cheshta Sharma, Shalini Duggal, Kshitij Agarwal, Anupam Prakash, Pradeep Kumar Singh, Sarika Jain, Shallu Kathuria, Harbans S. Randhawa, Ferry Hagen, and Jacques F. Meis
Candida auris
| Characteristic |
Case-patient no. |
|||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
|
| Age/sex |
3 d/F |
10 d/F |
28 d/F |
45 d/F |
10 y/M |
45 y/M |
47 y/F |
59 y/M |
60 y/F |
65 y/F |
67 y/M |
74 y/M |
| Diagnosis | PT, TEF, ICH sepsis | PT, ELBW, sepsis, DIC | Pneumonia, late onset sepsis | Meningitis, septic shock, PDA, ASD, fetal distress, IMV | ALL, CKD | Decompensated alcoholic liver cirrhosis, CKD, sepsis | DM, ESRD | HIV, cryptococcal meningitis, DM | ESRD, DM | Recurrence of ovarian carcinoma, DM | COPD exacerbation sepsis, DM, ESRD | Jejunal perforation, peritonitis, septicemia, MODS, DM |
| Risk factor | ||||||||||||
| Immunosuppression | + | + | – | + | + | + | + | + | + | + | + | + |
| Neutropenia (<109 cells/L) | + | + | + | - | + | – | – | + | – | + | – | – |
| CVC | – | + | + | + | + | – | – | – | – | – | – | + |
| Broad-spectrum antibiotics | + | + | + | + | + | – | - | + | + | + | – | + |
| Parenteral nutrition | – | – | – | - | – | – | - | – | – | – | – | – |
| Surgery within 30 d | – | – | – | + | – | – | - | – | – | – | + | + |
| Intensive care | + | + | + | + | + | + | - | – | – | – | – | + |
| Antifungals within 30 d | + | + | + | – | + | – | + | + | – | – | – | + |
| Concomitant bacteremia | + | + | + | + | – | – | - | + | – | – | – | + |
| Indwelling urinary catheter |
+ |
+ |
+ |
+ |
+ |
– |
+ |
+ |
– |
+ |
+ |
+ |
| Day of isolation |
3 |
3 |
20 |
10 |
18 |
1 |
3 |
21 |
9 |
1 |
Day 10 |
Day 21 |
| Therapy (dosage)* |
CAS (loading dose of 70 mg, then 50 mg daily) |
AMB (0.5 mg/kg BW) |
AMB (0.5 mg/kg BW) |
AMB (0.5 mg/kg BW) |
No antifungal given |
No antifungal given |
AMB (0.5 mg/kg BW) |
AMB (1 mg/kg BW) |
CAS (loading dose of 70 mg, then 50 mg daily) |
AMB (1 mg/kg BW) |
FLU (400 mg OD) |
CAS (loading dose of 70 mg, then 50 mg daily) |
| Duration of therapy |
5 d |
3 wk |
3 wk |
1 wk |
Not given |
Not given |
2 wk |
1 wk |
2 wk |
2 wk |
4 wk |
2 wk |
| Clearance of candidemia* |
NA |
10 d |
10 d |
7 d |
NA |
NA |
Not achieved after 14 d |
7 d |
10 d |
7 d |
3 wk |
10 d |
| Outcome | Died 8 d after admission | Discharge | Discharge | Discharge | Died 2 d after admission | Died on the day of admission | Died 17 d after admission | Died after 28 d | Discharged in a stable state | Discharged in a stable state | Discharged on 2 wk of FLU | Died 14 d after presentation |
*PT, pre-term; TEF, tracheo-esophageal fistula; ICH, intracranial hemorrhage; ELBW, extremely low birth weight; DIC, disseminated intravascular coagulation; PDA, patent ductus arteriosus; ASD, atrial septal defect; IMV, invasive mechanical ventilation; ALL, acute lymphocytic leukemia; CKD, chronic kidney disease; DM, diabetes mellitus; ESRD, end-stage renal disease; COPD, chronic obstructive pulmonary disease; MODS, multi organ dysfunction syndrome; CVC, central venous catheter; CAS, caspofungin; AMB, amphotericin B, FLU, fluconzaole; BW, body weight; NA, not assessed.
†Therapeutic failure was defined either as the persistence of Candida in the bloodstream despite adminstration of 3 d of antifungal therapy or as development of breakthrough candidemia while receiving antifungal agents for 3 d..