Background

Candida auris is an emerging multidrug-resistant and highly virulent yeast that spreads easily among patients.

Aims

To describe the characteristics of candidemia caused by C. auris in the southeast of Spain (Autonomous Community of Valencia – ACV) through a 5-year population-based study.

Methods

An analysis of all the episodes of candidemia diagnosed in the ACV, with approximately 4,500,000 inhabitants, during 2013–2017, was done. Data were obtained from the Epidemiological Surveillance Valencian Network, a network that collects all the microbiological data from the hospitals in the study region.

Results

Based on the records, 1.9% of the isolates recovered from the positive blood cultures (corresponding to 1789 patients) were yeasts. This implies an annual rate of 7.09 cases/100,000 inhabitants. Of the 23 yeast species isolated, Candida albicans was the most frequent (37.3%), showing a higher frequency than Candida parapsilosis (28.4%) and Candida glabrata (15.6%) (p < 0.0001). It is remarkable the emergence of C. auris during 2016 and 2017, as this species became the fourth more prevalent in 2016 (9.2%), and the third in 2017 (15.7%). Fungemia was more common in hospitals with >500 beds (63.3% versus 36.7% in small hospitals) (p < 0.0001), and C. auris was mostly isolated in large hospitals (8.5% versus 0.3%); its incidence was higher in autumn and among the age group of 65–84 years.

Conclusions

The information about the local epidemiology of candidemia is essential in order to decide the best empirical treatment approach. This study reports the novel presence of C. auris in large hospitals. This pathogen has usually resistance to several antifungals and causes severe fungemia, so the results of this work reveal the need to monitor the presence of this species systematically.

中文翻译：

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瓦伦西亚自治区大型医院中耳念珠菌的分离；基于人群的研究（2013-2017）

背景

念珠菌是一种新兴的多重耐药性和高毒力酵母菌，很容易在患者中传播。

宗旨

通过一项为期 5 年的基于人群的研究，描述西班牙东南部（瓦伦西亚自治区 - ACV）由耳念珠菌引起的念珠菌血症的特征。

方法

对 2013 年至 2017 年期间在大约 4,500,000 名居民中诊断出的 ACV 的所有念珠菌血症发作进行了分析。数据来自流行病学监测瓦伦西亚网络，该网络收集了研究地区医院的所有微生物数据。

结果

根据记录，从阳性血培养中回收的分离株中有 1.9%（对应 1789 名患者）是酵母菌。这意味着每年 7.09 例/100,000 居民。在分离的 23 种酵母菌中，白色念珠菌最为常见（37.3%），其频率高于近平滑念珠菌（28.4%）和光滑念珠菌（15.6%）（p  <  0.0001）。2016 年和 2017 年C. auris的出现令人瞩目，因为该物种在 2016 年成为第四大流行（9.2%），在 2017 年成为第三大流行（15.7%）。真菌血症在床位大于 500 的医院中更为常见（63.3% 对小医院的 36.7%）（p  <  0.0001），并且C. auris主要在大医院隔离（8.5% 对 0.3%）；秋季发病率较高，65～84岁年龄段发病率较高。

结论

有关当地念珠菌病流行病学的信息对于决定最佳经验性治疗方法至关重要。本研究报告了大型医院中耳念珠菌的新出现。这种病原体通常对几种抗真菌药具有抗性并导致严重的真菌血症，因此这项工作的结果表明需要系统地监测该物种的存在。