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Volume 25, Number 9—September 2019

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 3

Demographic and clinical characteristics of patients with Candida auris candidemia, by healthcare sector, South Africa, 2016–2017*

Characteristic Public-sector hospitals, n = 99 Private-sector hospitals, n = 695 p value†
Age, y, median (IQR)
27 (2–42)
58 (44–70)
Sex 0.64
Men and boys 63/99 (64) 221/364 (61) NA
Women and girls
36/99 (36)
143/364 (39)
Length of hospital stay, d, median (IQR) 49 (30–72) 68 (40–140) 0.03
Length of stay to first positive blood culture, d, median (IQR)
26 (13–42)
35 (16–58)
Hospital admission in past 12 mo 37/62 (60) 40/42 (95) <0.001
Intensive care unit admission
54/68 (79.4)
56/57 (98.3)
Mechanical ventilation 21/52 (40) 23/39 (59) 0.09
Central venous catheter in situ 40/54 (74) 29/38 (76) 1.0
Total parenteral nutrition
22/52 (42)
15/38 (39)
Systemic antimicrobial drug therapy <14 d before positive culture
36/52 (69)
41/42 (98)
Systemic antifungal drug therapy <14 d before positive culture‡ 14/53 (26) 16/42 (38) 0.27
Azole 12/14 (85.7) 4/16 (25) 0.001
Polyene/amphotericin B 4/14 (28.6) 3/16 (18.8) 0.68
0/14 (0)
13/16 (81.3)
Crude in-hospital mortality ratio 22/59 (37) 24/43 (56) 0.07

*Values are no. (%) except as indicated. Age data were available for 435 patients, and data on sex were available for 428 patients. For the rest of the variables, data were available for only a small proportion of patients from enhanced surveillance sites (total, N = 110; public sector, n = 67; private sector, n = 43). IQR, interquartile range; NA, not applicable.
†Proportions were compared by using a χ2 or Fisher exact test; medians were compared by using the Wilcoxon rank-sum test.
‡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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