P042 Identification, clinical profile, antifungal susceptibility pattern of candida auris from a tertiary care center in india
Authors: Danni Mary Kiran , Kindo Anupma Jyoti , Jayalakshmi J , Renuka M K 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

Objectives
To identify the phenotypic characteristics of Candida auris.
To analyze the clinical profile of Candida auris infection.
To describe the antifungal susceptibility pattern of Candida auris.

Methods
The study was conducted in the Department of Microbiology in Mycology division at Sri Ramachandra Institute of Higher Education and Research from December 2019 to November 2021. The study protocol was approved by Institutional Ethics Committee.
Candida species isolated from various specimens sent to the laboratory were identified by Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight mass spectrometry (MALDI-TOF). The growth characteristics of C. auris were investigated on various media including Selective Auris Medium (SAM), HiChrome agar Candida and Tetrazolium reduction agar.
Antifungal susceptibility testing was performed by using the Clinical and Laboratory Standards Institute broth microdilution method M27-A3. Antifungals tested were fluconazole, itraconazole, voriconazole, posaconazole, micafungin, anidulafungin, caspofungin and amphotericin B. Candida albicans American Type Culture Collection (ATCC) 22 019 was used as quality control strains.
Data were collected for demographics, risk factors for candidemia, treatment, and outcome from the respective wards and ICUs.

Results
A total of 37 C. auris isolates were collected. Both adult and pediatric cases were included. The majority (23.3%) of the C. auris cases were seen in the age group of 55-64. Median age was 54 years for the adults. Among the 7 children, 6 were neonates and 1 was an infant. The most common source of isolation is urine and blood.
A total of 35/37 isolates showed moderate to heavy growth on the SAM, while 2 isolates showed mild growth after 72 h. But all the other Candida species and other yeasts tested were inhibited on this medium. All the isolates of C. auris grew as cream to pinkish purple colonies on Hichrome agar Candida. On Tetrazolium reduction agar, all of them formed maroon colonies.
The average duration of hospital stay was 25 days (range 4-65). A total of 35 of the patients were admitted to ICU, 8 had undergone mechanical ventilation and intubation. Central venous catheter was inserted in 9 patients and post-operative catheter placed in 6 patients; 4 patients had undergone tracheostomy and 25 of them had undergone some other invasive procedure. Total parenteral nutrition was received by 3 patients, 16 were diabetics and 11 were hypertensives. Prior antifungal exposure was present in 9 patients and 26 had received broad-spectrum antibiotics.
The crude mortality rate with C. auris infection in patients was 32.43% and the attributable mortality rate, as considered by the treating physician was 10.81%.
Antifungal resistance was noted to be amphotericin B (n  =  15, 40.5%), fluconazole (n  =  30, 81.1%), voriconazole (n =  4, 10.81%), itraconazole (n  =  6, 16.21%), posaconazole (n = 5, 13.51%), caspofungin (n  =  4, 10.81%). Multidrug resistance was noted in 15 (40.54%) isolates and 3 isolates (5.4%) were resistant to a drug from all three groups.

Conclusion
C. auris poses a great threat to immunocompromised individuals and those admitted in ICUs for long term.