Ongoing Challenges with Healthcare-Associated Candida auris Outbreaks in Oman
Ongoing Challenges with Healthcare-Associated Candida auris Outbreaks in Oman
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DOI：
10.3390/jof5040101
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发表时间：
2019-12-01
期刊：
影响因子：
4.7
通讯作者：
Al-Hatmi, Abdullah M. S.
中科院分区：
文献类型：
--
作者：
Al Maani, Amal;Paul, Hema;Al-Hatmi, Abdullah M. S.
金黄色念珠菌在过去十年中已经成为一种对多种药物具有耐药性的公共卫生威胁，导致卫生保健暴发。在这里，我们报告了2018年4月至2019年4月期间阿曼一家地区性医院爆发的金黄色葡萄球菌疫情的流行病学、临床和微生物学调查。暴发始于重症监护区(重症监护病房、冠状动脉监护病房和高度依赖病房)，但随后在其他内外科病房确诊病例。除了患者的临床和筛查样本外，还收集了接触频率高的地区和35名工作人员手中的环境拭子。所有来自患者和环境筛选的阳性标本均经MALDI-TOF确认，并对10株临床分离株和2株环境分离株进行了ITS-rDNA测序。金黄色葡萄球菌阳性32例，其中尿路感染14例(43.8%)，念珠菌感染11例(34.4%)，皮肤无症状定植7例(21.8%)。中位年龄为(14~88岁)，男性17例(53.1%)，女性15例(46.9%)。确诊前，21例(65.6%)已入住重症监护病房，11例(34.4%)已在内科或外科病房接受护理。我们患者队列中的粗死亡率为53.1。从ICU两个不同病床的呼吸机上采集的两个拭子对金黄色葡萄球菌呈阳性。医护人员的样本中没有一份呈阳性。分子分型结果表明，临床分离株和环境分离株在遗传上相似，均属于南亚金黄色葡萄球菌。大多数分离株对氟康唑(100%)和两性霉素B(33%)不敏感，但对棘球菌素和伏立康唑的MIC较低。尽管采取了多模式感染预防和控制措施，但新病例继续出现，对所有遏制努力提出了挑战。
Candida auris has emerged in the past decade as a multi-drug resistant public health threat causing health care outbreaks. Here we report epidemiological, clinical, and microbiological investigations of a C. auris outbreak in a regional Omani hospital between April 2018 and April 2019. The outbreak started in the intensive care areas (intensive care unit (ICU), coronary care unit (CCU), and high dependency unit) but cases were subsequently diagnosed in other medical and surgical units. In addition to the patients' clinical and screening samples, environmental swabs from high touch areas and from the hands of 35 staff were collected. All the positive samples from patients and environmental screening were confirmed using MALDI-TOF, and additional ITS-rDNA sequencing was done for ten clinical and two environmental isolates. There were 32 patients positive for C. auris of which 14 (43.8%) had urinary tract infection, 11 (34.4%) had candidemia, and 7 (21.8%) had asymptomatic skin colonization. The median age was 64 years (14-88) with 17 (53.1%) male and 15 (46.9%) female patients. Prior to diagnosis, 21 (65.6%) had been admitted to the intensive care unit, and 11 (34.4%) had been nursed in medical or surgical wards. The crude mortality rate in our patient's cohort was 53.1. Two swabs collected from a ventilator in two different beds in the ICU were positive for C. auris. None of the health care worker samples were positive. Molecular typing showed that clinical and environmental isolates were genetically similar and all belonged to the South Asian C. auris Glade I. Most isolates had non-susceptible fluconazole (100%) and amphotericin B (33%) minimal inhibitory concentrations (MICs), but had low echinocandin and voriconazole MICs. Despite multimodal infection prevention and control measures, new cases continued to appear, challenging all the containment efforts.