Axillary Digital Thermometers uplifted a multidrug-susceptible Candida auris outbreak among COVID-19 patients in Brazil

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Nobrega de Almeida, Jr., Joao ^{[1, 2]} ; Brandao, Igor B. ^[3] ; Francisco, Elaine C. ^[1] ; de Almeida, Silvio Luis R. ^[4] ; de Oliveira Dias, Patricia ^[4] ; Pereira, Felicidade M. ^[5] ; Santos Ferreira, Fabio ^[5] ; de Andrade, Thaisse Souza ^[6] ; de Miranda Costa, Magda M. ^[7] ; de Souza Jordao, Regiane T. ^[8] ; Meis, Jacques F. ^{[9, 10]} ; Colombo, Arnaldo L. ^[1] ; auris Brazilian Study Grp, Candida

Afiliação do(s) autor(es)

^[1] Univ Fed Sao Paulo, Disciplina Infectol, Escola Paulista Med, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Cent Lab Div, Hosp Clin, Sao Paulo - Brazil

^[3] Hosp Bahia, Comissao Controle Infeccao Hosp, Salvador, BA - Brazil

^[4] Minist Saude, EpiSUS, Secretaria Vigilancia Saude, Brasilia, DF - Brazil

^[5] Lab Cent Saude Publ Prof Goncalo Muniz, Salvador, BA - Brazil

^[6] Secretaria Saude Estado Bahia, Superintendencia Vigilancia & Protecao Saude, Salvador, BA - Brazil

^[7] Minist Saude, Brazilian Hlth Regulatory Agcy, Brasilia, DF - Brazil

^[8] Minist Saude, CGLAB, Brasilia, DF - Brazil

^[9] ECMM Ctr Excellence Med Mycol, Dept Med Microbiol & Infect Dis, Nijmegen - Netherlands

^[10] Radboud Univ Nijmegen, Med Ctr, Ctr Expertise Mycol, Canisius Wilhelmina Hosp, Nijmegen - Netherlands

• Tipo de documento: Artigo Científico
• Fonte: MYCOSES; v. 64, n. 9, p. 1062-1072, SEP 2021.
• Citações Web of Science: 1

Resumo

Objectives To describe the first outbreak of Candida auris in Brazil, including epidemiological, clinical and microbiological data. Methods After the first Candida auris-colonised patient was diagnosed in a COVID-19 ICU at a hospital in Salvador, Brazil, a multidisciplinary team conducted a local C. auris prevalence investigation. Screening cultures for C. auris were collected from patients, healthcare workers and inanimate surfaces. Risk factors for C. auris colonisation were evaluated, and the fungemia episodes that occurred after the investigation were also analysed and described. Antifungal susceptibility of the C. auris isolates was determined, and they were genotyped with microsatellite analysis. Results Among body swabs collected from 47 patients, eight (n = 8/47, 17%) samples from the axillae were positive for C. auris. Among samples collected from inanimate surfaces, digital thermometers had the highest rate of positive cultures (n = 8/47, 17%). Antifungal susceptibility testing showed MICs of 0.5 to 1 mg/L for AMB, 0.03 to 0.06 mg/L for voriconazole, 2 to 4 mg/L for fluconazole and 0.03 to 0.06 mg/L for anidulafungin. Microsatellite analysis revealed that all C. auris isolates belong to the South Asian clade (Clade I) and had different genotypes. In multivariate analysis, having a colonised digital thermometer was the only independent risk factor associated with C. auris colonisation. Three episodes of C. auris fungemia occurred after the investigation, with 30-day attributable mortality of 33.3%. Conclusions Emergence of C. auris in Salvador, Brazil, may be related to local C. auris clade I closely related genotypes. Contaminated axillary monitoring thermometers may facilitate the dissemination of C. auris reinforcing the concept that these reusable devices should be carefully cleaned with an effective disinfectant or replaced by other temperature monitoring methods. (AU)

• Processo FAPESP: 17/02203-7 - Rede multidisciplinar internacional para caracterização de aspectos microbiológicos e da história natural de Infecções Fúngicas Invasivas (IFI) por espécies do gênero Candida
• Beneficiário: Arnaldo Lopes Colombo
• Modalidade de apoio: Auxílio à Pesquisa - Temático