379. Pediatric Bloodstream Infections by Candida auris in Colombia: Clinical Characteristics and Outcomes of 34 cases
Session: Poster Abstract Session: Fungal Disease: Management and Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Bloodstream infections with Candida auris among children in Colombia.pdf (1.0 MB)
  • ABSTRACT

    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 2015–September 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: 17–30 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.

    Indira Berrio, MD, MSc1,2, Diego H Caceres, MSc3,4, Wilfrido Coronell R, MD, PhD5, Soraya Salcedo, MD, MSc6, Laura Mora, MD7, Adriana Marin, MSc7, Carmen Varón, .8, Patricia Escandón, MSc9, Sandra Rivera, .9, Tom Chiller, MD, MPH10 and Snigdha Vallabhaneni, MD, MPH10, (1)Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellin, Colombia, (2)Hospital general de Medellin “Luz Castro de Gutiérrez” ESE, Medellín, Colombia, (3)Centers for Disease Control and Prevention, Atlanta, GA, United States of America, Atlanta, GA, (4)Oak Ridge Institute for Science and Education (ORISE), Oak Ridge,, Nashville, TN, (5)Infectious diseases pediatrician, Universidad de Cartagena., Cartagena, Colombia, (6)Clínica General del Norte, Barranquilla, Colombia, (7)Clinical General del Norte, Barranquilla, Colombia., Barranquilla, Colombia, (8)Fundacion UCI Doña Pilar, Cartagena, Colombia, Cartagena, Colombia, (9)Instituto Nacional de Salud (INS), Bogota, Colombia., Bogota, Colombia, (10)Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA

    Disclosures:

    I. Berrio, None

    D. H. Caceres, None

    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

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.