Volume 26, Number 5—May 2020
Synopsis
Clinical Outcomes of Patients Treated for Candida auris Infections in a Multisite Health System, Illinois, USA
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.