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Volume 26, Number 5—May 2020
Synopsis

Clinical Outcomes of Patients Treated for Candida auris Infections in a Multisite Health System, Illinois, USA

Kellie Arensman, Jessica L. Miller, Anthony Chiang, Nathan Mai, Joseph Levato, Erik LaChance, Morgan Anderson, Maya Beganovic, and Jennifer Dela PenaComments to Author 
Author affiliations: Advocate Lutheran General Hospital, Park Ridge, Illinois, USA (K. Arensman, M. Beganovic, J. Dela Pena); Advocate South Suburban Hospital, Hazel Crest, Illinois, USA (J.L. Miller); Advocate Trinity Hospital, Chicago, Illinois, USA (J.L. Miller); Swedish Covenant Hospital, Chicago (A. Chiang); Advocate Christ Medical Center, Oak Lawn, Illinois, USA (N. Mai, J. Levato); Advocate Illinois Masonic Medical Center, Chicago (E. LaChance); Advocate Condell Medical Center, Libertyville, Illinois, USA (M. Anderson); Advocate Good Shepherd Hospital, Barrington, Illinois, USA (M. Anderson)

Main Article

Table 2

Demographic and clinical characteristics of patients treated for Candida auris infections in a multisite health system, Illinois, USA*

Patient age, y/sex Culture source (infection type) Empiric treatment Definitive treatment Treatment duration Outcome Comments
83/M
 Urine (CA-UTI)
 Micafungin 100 mg IV every 24 h
 Micafungin 100 mg IV every 24 h
 5 d
 Clinical success
 Trach to vent patient with dementia. Urine culture earlier in admission showed 10,000–50,000 CFU C. auris, but thought to be colonization and was not treated. Repeat urine culture showed >100,000 CFU C. auris, and patient was treated.
56/M
 Blood (CLABSI)
 Micafungin 100 mg IV every 24 h
 Fluconazole 200 mg per PEG every 24 h
 15 d
 Clinical success
 Trach to vent patient with ESRD on HD with tunneled catheter, also had a PICC. Both lines were removed.
73/M
 Blood (CLABSI)
 Micafungin 100 mg IV every 24 h
 Micafungin 100 mg IV every 24 h
 17 d
 Clinical success
 Trach to vent patient with ESRD on HD with tunneled catheter, chronic osteomyelitis of the coccyx. C. auris from culture of HD line at SNF. Tunneled catheter removed.
64/F
 Blood (CLABSI)
 Micafungin 100 mg IV every 24 h
 Micafungin 100 mg IV every 24 h
 26 d
 Died
 Trach to vent patient with ESRD on HD with chest port and PICC for TPN. Lines removed. 42 d of therapy planned; patient readmitted for presumed septic shock and died on day 26 after being switched to comfort care. No growth of any organisms in cultures on readmission.
61/M
 Catheter tip
 Micafungin 100 mg IV every 24 h
 Micafungin 100 mg IV every 24 h
 21 d
 Clinical success
 Trach patient with ESRD on HD with tunneled catheter admitted for fungemia. Started on micafungin before admission. Line removed. Azole not used because of concomitant amiodarone.
74/M
 Urine (CA-UTI)
 Micafungin 100 mg IV every 24 h
 Micafungin 100 mg IV every 24 h
 Unknown
 Clinical success
 Trach to vent patient. Patient transferred to SNF before culture finalized; duration of micafungin to be determined by SNF.
74/F
 Blood (CLABSI)
 Micafungin 100 mg IV every 24 h
 Fluconazole 400 mg PO every 24 h
 21 d
 Clinical success
 SNF patient on chronic TPN for enterocutaneous fistulas, history of line infections and infective endocarditis. Persistently fungemic for 4 d until tunneled central line was removed.
50/F
 Abdominal wound
 Micafungin 100 mg IV every 24 h
 Micafungin 100 mg IV every 24 h
 10 d
 Clinical success
 Patient with obesity, diabetes, and chronic abdominal/groin ulcers hospitalized for DKA; receives wound care at home. Ulcers underwent debridement; C. auris, CoNS, and Corynebacterium grew from operative cultures.
78/M
 Blood
Fluconazole 400 mg IV every 24 h
 Itraconazole 200 mg per PEG every 24 h
 14 d
 Clinical success
 Trach to vent after cardiac arrest, midline POA for hypotension and hypoxia. Midline thought to be source. Discharged to hospice, but continued antifungal therapy. Lost to follow-up.
79/M
 Blood (CLABSI)
 Micafungin 100 mg IV every 24 h
 Micafungin 100 mg IV every 24 h
 5 d
 Died
 Trach, ESRD on HD with tunneled catheter. Blood culture also showed growth of Proteus mirabilis. Died from septic shock after switching to comfort care. Repeat blood cultures showed no growth.
78/F
 Hip synovial fluid
 Micafungin 100 mg IV every 24 h
 Micafungin 100 mg IV every 24 h
 6 d
 Clinical success
 ESRD on HD with tunneled catheter, DM, prosthetic mitral valve, treated for drainage from hip after hip replacement 3 mo prior, had onset of septic shock after I&D procedure. C auris isolated from hip aspirate. Antifungal treatment stopped after 6 d because C. auris was a suspected contaminant. Died in hospital >30 d after C auris isolation.
82/M Blood (CLABSI) Micafungin 100 mg IV every 24 h Micafungin 100 mg IV every 24 h 14 d Clinical success Patient with functional quadriplegia after CVA. Trach, PEG, PICC, and chronic foley catheter POA. PICC removed.

*CA-UTI, catheter-associated urinary tract infection; CFU, colony forming units; CLABSI, catheter-associated urinary tract infection; CoNS, coagulase negative Staphylococci; CVA, cerebral vascular accident; DKA, diabetic ketoacidosis; DM, diabetes mellitus; ESRD, end-stage renal disease; HD, hemodialysis; I&D, incision and debridement; PEG, percutaneous endoscopic gastrostomy; PICC, peripherally inserted central catheter; POA, present on admission; SNF, skilled nursing facility; TPN, total parenteral nutrition; trach, tracheotomy; vent, ventilator.

Main Article

Page created: April 16, 2020
Page updated: April 16, 2020
Page reviewed: April 16, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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