Epidemiological Characteristics of Candida auris Candiduria

Öz

Background: Candida auris infections have become a significant global clinical problem due to their increasing frequency, especially in intensive care patients, and high rates of antifungal resistance. This study aimed to evaluate the epidemiological characteristics and antifungal susceptibility profiles of candiduria caused by C. auris.

Materials and Methods: Demographic data of 115 patients whose urine cultures grew C. auris were analyzed retrospectively at the Microbiology Laboratory of Adana City Training and Research Hospital between February and September 2025. Species identification of isolates was performed using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) with a Microflex LT MALDI-TOF MS system (Bruker Daltonics, Bremen, Germany). Antifungal susceptibility testing was performed using the Sensititre YeastOne YO10 AST (Thermo Scientific™, Waltham, MA, USA) commercial kit, and results were interpreted according to the tentative breakpoints recommended by the Centers for Disease Control and Prevention.

Results: The median age of patients was 65, and 62.6% of the cases were male patients. It was determined that clinical samples were sent more frequently from intensive care unit (76.5%) [internal medicine (18.3%), anesthesiology and resuscitation (17.4%), brain surgery (10.4%) and neurology (9.6%)]. The highest resistance rates were found for fluconazole (n=130, 99.2%) and amphotericin B (n=88, 67.2%), respectively. The resistance rates for caspofungin, micafungin, and anidulafungin were 9.2%, 5.3%, and 3.8%, respectively. The proportion of pan-resistant isolates was found to be 6.9% (n=9/131). Resistance development was detected in two cases under echinocandin treatment.

 Conclusions: Candida auris candiduria is associated with advanced age, intensive care unit admission, and the presence of a urinary catheter. Multiple antifungal resistance creates significant therapeutic challenges. Therefore, routine antifungal susceptibility testing for each isolate, strengthening epidemiological surveillance, and implementing control strategies to prevent resistance development are critical for the effective management of C. auris infections.

 

Anahtar Kelimeler

• Candida auris
• candiduria
• epidemiology
• antifungal resistance

Candida auris Kandidürilerinin Epidemiyolojik Özellikleri

Öz

Amaç: Candida auris enfeksiyonları, özellikle yoğun bakım hastalarında artan sıklığı ve yüksek antifungal direnç oranları nedeniyle küresel ölçekte önemli bir klinik sorun haline gelmiştir. Bu çalışma, C. auris kaynaklı kandidürilerin epidemiyolojik özellikleri ile antifungal duyarlılık profillerini değerlendirmeyi amaçlamaktadır.

Materyal ve metod: Şubat-Eylül 2025 tarihleri arasında Adana Şehir Eğitim ve Araştırma Hastanesi Mikrobiyoloji Laboratuvarı’nda idrar kültürlerinde C. auris üreyen 115 hastanın demografik verileri retrospektif olarak incelendi. İzolatların tür tanımlaması, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) yöntemi ile Microflex LT MALDI-TOF MS (Bruker Daltonics, Bremen, Almanya) sistemi kullanılarak yapıldı. Antifungal duyarlılık testleri Sensititre YeastOne YO10 AST (Thermo Scientific™, Waltham, MA, ABD) ticari kiti kullanılarak yapıldı ve sonuçlar Centers for Disease Control and Prevention tarafından önerilen geçici sınır değerlerine göre yorumlandı.

Bulgular: Hastaların medyan yaşı 65 olup olguların %62,6’sı erkek hastalardan oluşmakta idi. Klinik örneklerin daha sıklıkla yoğun bakım ünitelerinden (%76,5) [dahiliye (%18,3), anesteziyoloji ve reanimasyon (%17,4), beyin cerrahisi (%10,4) ve nöroloji (%9,6)] gönderildiği belirlendi. En yüksek direnç oranları sırası ile flukonazol (n=130, %99,2) ve amfoterisin B (n=88, %67,2) için bulundu.  Kaspofungin, mikafungin ve anidulafungin direnç oranları, sırası ile, %9,2, %5,3 ve %3,8 idi. Pan-rezistan izolatların oranı %6,9 (n=9/131) tespit edildi. Ekinokandin tedavisi altında iki olguda direnç gelişimi tespit edildi.

Sonuç: Candida auris kandidürileri, ileri yaş, yoğun bakım yatışı ve üriner kateter varlığı ile ilişkilidir. Çoklu antifungal ilaç direnci, tedavi yaklaşımlarında önemli güçlükler yaratmaktadır. Bu nedenle, her izolat için antifungal duyarlılık testlerinin rutin uygulanması, epidemiyolojik sürveyansın güçlendirilmesi ve direnç gelişimini önleyici kontrol stratejilerinin benimsenmesi C. auris enfeksiyonlarının etkin yönetimi açısından kritik öneme sahiptir.

 

Anahtar Kelimeler

• Candida auris
• kandidüri
• epidemiyoloji
• antifungal direnç

Kaynakça

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