Candida auris in Greek healthcare facilities: Active surveillance results on first cases and outbreaks from eleven hospitals within Attica region

Lida Politi; Georgia Vrioni; Sofia Hatzianastasiou; Malvina Lada; Maria Martsoukou; Nikolaos V Sipsas; Maria Chini; Vasiliki Baka; Eleni Kafkoula; Aikaterini Masgala; Maria Pirounaki; Christos Michailidis; Georgios Chrysos; Olympia Zarkotou; Vasiliki Mamali; Vasileios Papastamopoulos; Georgios Saroglou; Spyros Pournaras; Joseph Meletiadis; Ioannis Karakasiliotis; Stefanos Karachalios; Stavroula Smilakou; Vasiliki Skandami; Maria Orfanidou; Athina Argyropoulou; Athanassios Tsakris; Flora Kontopidou; Candida auris study collaborative group

doi:10.1016/j.mycmed.2024.101477

Candida auris in Greek healthcare facilities: Active surveillance results on first cases and outbreaks from eleven hospitals within Attica region

J Mycol Med. 2024 Mar 26;34(2):101477. doi: 10.1016/j.mycmed.2024.101477. Online ahead of print.

Authors

Lida Politi¹, Georgia Vrioni², Sofia Hatzianastasiou³, Malvina Lada⁴, Maria Martsoukou⁵, Nikolaos V Sipsas⁶, Maria Chini⁷, Vasiliki Baka⁸, Eleni Kafkoula⁸, Aikaterini Masgala⁹, Maria Pirounaki¹⁰, Christos Michailidis¹¹, Georgios Chrysos¹², Olympia Zarkotou¹³, Vasiliki Mamali¹³, Vasileios Papastamopoulos¹⁴, Georgios Saroglou¹⁵, Spyros Pournaras¹⁶, Joseph Meletiadis¹⁶, Ioannis Karakasiliotis¹⁷, Stefanos Karachalios¹⁸, Stavroula Smilakou¹⁹, Vasiliki Skandami²⁰, Maria Orfanidou²¹, Athina Argyropoulou²², Athanassios Tsakris², Flora Kontopidou²³; Candida auris study collaborative group

Affiliations

¹ ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), Department of Microbial Resistance and Infections in Health Care Settings, Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, Athens, Greece. Electronic address: l.politi@eody.gov.gr.
² Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Greece.
³ Department of Microbial Resistance and Infections in Health Care Settings, Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, Athens, Greece.
⁴ Second Department of Internal Medicine, "Sismanogleio" General Hospital of Athens, Athens, Greece.
⁵ Department of Microbiology, "Sismanogleio" General Hospital, Athens, Greece.
⁶ Infectious Diseases Unit, "Laikon" General Hospital, and Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁷ 3rd Department of Internal Medicine and Infectious Diseases Unit, "Korgialeneion-Benakeion" General Hospital, Athens, Greece.
⁸ Microbiology Department, "Korgialeneion-Benakeion" General Hospital, Athens, Greece.
⁹ 2nd Department of Internal Medicine, "Konstantopouleio" General Hospital, Athens, Greece.
¹⁰ Department of Medicine and Laboratory, National and Kapodistrian University of Athens Medical School, "Hippokration" General Hospital, Athens, Greece.
¹¹ 1st Department of Internal Medicine, "Georgios Gennimatas" General Hospital of Athens, Athens, Greece.
¹² 2nd Department of Medicine and Infectious Diseases Unit, Tzaneio Hospital, Piraeus, Greece.
¹³ Department of Microbiology, Tzaneio Hospital, Piraeus, Greece.
¹⁴ 5th Department of Internal Medicine and Infectious Diseases Unit, "Evaggelismos" General Hospital, Athens, Greece.
¹⁵ Medical School, National & Kapodistrian University of Athens, Athens, Greece.
¹⁶ Department of Clinical Microbiology, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
¹⁷ Laboratory of Biology, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
¹⁸ Department of Microbiology, "Agioi Anargyroi" General Oncology Hospital, Athens, Greece.
¹⁹ Department of Microbiology, "Laikon" General Hospital, Athens, Greece.
²⁰ Department of Microbiology, "Hippokration" Athens General Hospital, Athens, Greece.
²¹ Microbiology Department, "Georgios Gennimatas" General Hospital, Athens, Greece.
²² Department of Clinical Microbiology, "Evaggelismos" General Hospital, Athens, Greece.
²³ Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, Athens, Greece.

PMID: 38574412
DOI: 10.1016/j.mycmed.2024.101477

Abstract

Background: Candida auris was sporadically detected in Greece until 2019. Thereupon, there has been an increase in isolations among inpatients of healthcare facilities.

Aim: We aim to report active surveillance data on MALDI-TOF confirmed Candida auris cases and outbreaks, from November 2019 to September 2021.

Methods: A retrospective study on hospital-based Candida auris data, over a 23-month period was conducted, involving 11 hospitals within Attica region. Antifungal susceptibility testing and genotyping were conducted. Case mortality and fatality rates were calculated and p-values less than 0.05 were considered statistically significant. Infection control measures were enforced and enhanced.

Results: Twenty cases with invasive infection and 25 colonized were identified (median age: 72 years), all admitted to hospitals for reasons other than fungal infections. Median hospitalisation time until diagnosis was 26 days. Common risk factors among cases were the presence of indwelling devices (91.1 %), concurrent bacterial infections during hospitalisation (60.0 %), multiple antimicrobial drug treatment courses prior to hospitalisation (57.8 %), and admission in the ICU (44.4 %). Overall mortality rate was 53 %, after a median of 41.5 hospitalisation days. Resistance to fluconazole and amphotericin B was identified in 100 % and 3 % of tested clinical isolates, respectively. All isolates belonged to South Asian clade I. Outbreaks were identified in six hospitals, while remaining hospitals detected sporadic C. auris cases.

Conclusion: Candida auris has proven its ability to rapidly spread and persist among inpatients and environment of healthcare facilities. Surveillance focused on the presence of risk factors and local epidemiology, and implementation of strict infection control measures remain the most useful interventions.

Keywords: Active surveillance; Antifungal susceptibility; Candida auris; Emerging pathogen; Hospital acquired infections; Infection prevention and control measures.