Background: The emerging multidrug-resistant yeast Candida auris can cause invasive infections associated with high mortality. To date, a majority of C. auris infections have been reported among adults. This report describes cases of pediatric C. auris bloodstream infections (BSI) that occurred during January 2015September 2016 at two hospitals in Colombia.
Methods: After the Colombian National Institute of Health released a clinical alert about C. auris in September 2016, we conducted a retrospective review of microbiology records for possible C. auris cases in two acute care hospitals in Barranquilla and Cartagena. BSIs occurring in patients <18 years confirmed as C. auris were included in this analysis. Patient information was collected from medical records.
Results: We identified 34 children with C. auris BSI. Cases appeared to cluster in time within each hospital (Figure 1). Twenty-two (65%) patients were male, 21% were <28 days old, 47% were 29-365 days old, and 32% were >1 year. Underlying conditions included preterm birth (26%), altered nutritional status (59%), cancer (12%), solid organ transplant (3%), and renal disease (3%). Eighty-two percent had a central venous catheter (CVC), 82% on respiratory support, 56% received total parenteral nutrition (TPN), 15% had a surgical procedure, and 9% received hemodialysis. All patient received antibiotics in the 14 days before C. auris BSI, and 97% received antifungal treatment for BSI. Median inpatient stay before onset of C. auris BSI was 22 days (interquartile range: 1730 days), and in-hospital mortality was 41%.
Conclusion: Similar to other Candida BSI, C. auris affects children with a variety of medical conditions including prematurity, malignancy, and those with CVCs, and receiving TPN. Mortality was high, with nearly half of patients dying before discharge. However, unlike most other Candida species, C. auris can be transmitted in healthcare settings, as suggested by the close clustering of cases in time at each of the hospitals. Pediatric wards should be vigilant for C. auris outbreaks and take necessary infection control measures to stop the spread of the organism.
Figure 1. Timeline of cases of C. auris pediatric bloodstream infections in two medical institutions in Colombia, January 2015-September 2016.
W. Coronell R, None
S. Salcedo, None
L. Mora, None
A. Marin, None
C. Varón, None
P. Escandón, None
S. Rivera, None
T. Chiller, None
S. Vallabhaneni, None