Candida auris Candidemia in Kuwait, 2014

摘要

To the Editor: Recent reports from Asia (1–4) have highlighted the increasing incidence of the fungus Candida auris as a nosocomial bloodstream pathogen affecting persons of all age groups. We report a case of C. auriscandidemia in a 27-year-old woman in Kuwait with a long history of chronic renal failure. On May 9, 2014, the patient was admitted to the intensive care unit with symptoms of septic shock secondary to lobar pneumonia and complicated by acute renal failure. The patient was known to have immotile cilia syndrome (primary ciliary dyskinesia) and bronchiectasis with recurrent episodes of sinusitis. Beginning on day 1, she received treatment with different courses of a wide range of broad-spectrum antimicrobial drugs. However, despite treatment, the patient’s condition continued to deteriorate. On day 12 after admission, a blood culture yielded yeast growth that was identified with 99% probability as C. haemulonii by using the Vitek 2 yeast identification system (bioMérieux, Marcy l’Etoile, France). As part of routine patient care, we sent the isolate (Kw1732/14) to the Mycology Reference Laboratory at Kuwait University for further identification and antifungal susceptibility testing. The isolate was resistant to fluconazole (MIC of >256 μg/mL), but it appeared susceptible to amphotericin B (MIC of 0.064 μg/mL), voriconazole (MIC of 0.38 μg/mL), and caspofungin (MIC of 0.064 μg/mL) by using the Etest (bioMérieux, Marcy l’Etoile, France). The patient was started on liposomal amphotericin B (150 mg/day), but the next day, she died from multiorgan failure.