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Volume 25, Number 9—September 2019
Research

Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–20171

Erika van Schalkwyk2, Ruth S. Mpembe, Juno Thomas, Liliwe Shuping, Husna Ismail, Warren Lowman, Alan S. Karstaedt, Vindana Chibabhai, Jeannette Wadula, Theunis Avenant, Angeliki Messina, Chetna N. Govind, Krishnee Moodley, Halima Dawood, Praksha Ramjathan, Nelesh P. Govender2Comments to Author , and for GERMS-SA
Author affiliations: National Institute for Communicable Diseases, Johannesburg, South Africa (E. van Schalkwyk, R.S. Mpembe, J. Thomas, L. Shuping, H. Ismail, N.P. Govender); Vermaak & Partners–Pathcare Pathologists, Johannesburg (W. Lowman); Wits Donald Gordon Medical Centre, Johannesburg (W. Lowman); University of the Witwatersrand, Johannesburg (W. Lowman, A.S. Karstaedt, V. Chibabhai, J. Wadula, A. Messina, N.P. Govender); University of Pretoria and Kalafong Provincial Tertiary Hospital, Pretoria, South Africa (T. Avenant); Netcare Hospitals Ltd, Johannesburg (A. Messina); Lancet Laboratories, Durban, South Africa (C.N. Govind, K. Moodley); University of KwaZulu-Natal, Durban (C.N. Govind, H. Dawood, P. Ramjathan); Grey’s Hospital, Pietermaritzburg, South Africa (H. Dawood); National Health Laboratory Service, Johannesburg (V. Chibabhai, J. Wadula, P. Ramjathan)

Main Article

Table 2

Demographic and clinical characteristics of 6,669 patients with candidemia caused by Candida auris compared with other Candida species, South Africa, 2016–2017*

Characteristics All candidemia C. auris Non–C. auris C. parapsilosis C. albicans C. glabrata
No. case-patients
 6,669
 794
 5,875
 2,600
 1,353
 598
Systemic antifungal drug therapy <14 d before positive culture†
 317/1,829 (17.3)
 30/95 (31.6)
 287/1,734 (16.6)
 108/477 (22.6)
 36/441 (8.2)
 11/166 (6.6)
Azole
 219/317 (69.1)
 16/30 (53.3)
 203/287 (70.7)
 72/108 (66.7)
 30/36 (83.3)
 9/11 (81.8)
Polyene/amphotericin B
 38/317 (12)
 7/30 (23.3)
 31/287 (10.8)
 12/108 (11.1)
 5/36 (13.9)
 0/11 (0)
Echinocandin
 79/317 (24.9)
 13/30 (43.3)
 66/287 (23)
 27/108 (25)
 2/36 (5.6)
 2/11 (18.2)
Age, y, median (IQR)
 32 (0–58)
 54 (34–67)
 27 (0–57)
 24 (0–58)
 24 (0–56)
 54 (32–67)
Sex
Men and boys
 2,013/3,679 (54.7)
 284/463 (61.3)
 1,729/3,216 (53.8)
 806/1474 (54.7)
 533/978 (54.5)
 232/444 (52.3)
Women and girls
 1,666/3,679 (45.3)
 179/463 (38.7)
 1,487/3,216 (46.2)
 668/1,474 (45.3)
 445/978 (45.5)
 212/444 (47.7)
Length of hospital stay, d median (IQR)
 32 (16–54)
 55 (32–81)
 31 (15–52)
 40 (25–59)
 24 (12–43)
 22 (9–41)
Length of stay until first positive blood culture, d, median (IQR)
 13 (5–24)
 28 (15–46)
 12 (5–23)
 16 (10–27)
 10 (3–19)
 6 (1–16)
Province
Gauteng
 4,229/6,669 (63.4)
 680/794 (85.6)
 3,549/5,875 (60.4)
 1,651/2,600 (63.5)
 736/1,353 (54.4)
 323/598 
(54)
Other
 2,440/ 6,669 (36.6)
 114/794 (14.4)
 2,326/5,875 (39.6)
 949/2,600 (36.5)
 617/1,353 (45.6)
 275/598 
(46)
Healthcare sector
Public
 2,529/6,669 (37.9)
 99/794 
(12.5)
 2,430/5,875 (41.4)
 599/2,600 (23)
 673/1,353 (49.7)
 248/598 (41.5)
Private
 4,140/6,669 (62.1)
 695/794 (87.5)
 3,445/5,875 (58.6)
 2,001/2,600 (77)
 680/1,353 (50.3)
 350/598 (58.5)
Hospital admission in past 12 mo
 1,428/1,967 (72.6)
 77/104 
(74)
 1,351/1,863 (72.5)
 378/529 
(71.5)
 341/486 (70.2)
 126/174 (72.4)
Intensive care unit admission
 1,579/2,167 (72.9)
 110/125 
(88)
 1,469/2,042 (71.9)
 502/606 
(82.8)
 377/539 (69.9)
 133/190 
(70)
Mechanical ventilation
 611/1,818 
(33.6)
 44/91 
(48.4)
 567/1,727 
(32.8)
 175/476 
(36.8)
 129/440 (29.3)
 57/165 (34.6)
Central venous catheter in situ
 1,031/1,817 (56.7)
 69/92 
(75)
 962/1,725 
(55.8)
 289/479 
(60.3)
 229/443 (51.7)
 89/165 (53.9)
Systemic antimicrobial drug therapy in 14 d before positive culture
 1,292/1,830 (70.6)
 77/94 
(81.9)
 1,215/1,736 
(70)
 349/481 
(72.6)
 284/441 (64.4)
 105/164 (64.0)
Crude in-hospital case-fatality ratio 8,39/1,966
 (42.7) 46/102 
(45.1) 793/1,864 
(42.5) 166/516 
(32.2) 247/492 (50.2) 91/179 (50.8)

*Values are no. (%) except as indicated. The 3 most common Candida species in the non–C. auris group (C. parapsilosis, C. albicans, and C. glabrata) are shown separately for comparison. For the purpose of this analysis, cases of candidemia with no final species identification were included in the non–C. auris group. IQR, interquartile range.
†Patients could have received >1 class of antifungal drug therapy.

Main Article

1Preliminary results from this study were presented at the Federation of Infectious Diseases Societies of Southern Africa (FIDSSA) conference (oral abstract no. 8,382), November 9–11 2017, Cape Town, South Africa.

2These authors contributed equally to this article.

Page created: August 21, 2019
Page updated: August 21, 2019
Page reviewed: August 21, 2019
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