First Isolation of C. auris in a Patient with a Polymicrobial Wound Infection in Jamaica

Background: First discovered in Japan in 2009, C. auris has since emerged as an important nosocomial pathogen. It has been difficult to identify without techniques such as the MALDI-TOF and PCR. Due to its potential p an-drug resistance, it is listed as a serious threat by the CDC and a priority pathogen by the WHO. Case Report: A 60 y/o woman with a history of Sickle Cell Disease (HbSS) and Rheumatoid Arthritis presented with chronic bilateral leg ulcers as well as a 2-week history of bilateral joint and leg pain. Initially her ulcers did not appear infected. Subsequent visits, showed signs of infection with bacterial and fungal aetiology included in the differential. Positive results were limited to 4 wound samples which grew Candida auris as well as Fusarium spp, Pseudomonas aeruginosa, Escherichia coli, Providencia stuartii and Pseudomonas mendocina. In the absence of susceptibility test results initially, the patient was started empirically on levofloxacin PO, itraconazole PO and terbinafine topically and was able to clear the C. auris infection. C. auris was confirmed from the wound sample using MALDI-TOF and susceptbility tests were conducted using the Vitek-2 (® Biomerieux). The C. auris maintained susceptibility to the major antifungals tested. Fluconazole had an MIC (mcg/ml) of 1, Caspofungin ≤ 0.12, Amphotericin B 0.5. Itraconozaole was not included on the Vitek-2 (® Biomerieux) panel used for susceptibility testing (YS08). Discussion: C. auris was detected in an immunocompromised patient. Notably, the C. auris was susceptible to all major antifungals tested based on CDC proposed breakpoints. Clearance of C. auris post-treatment with itraconazole suggests its effectiveness in this case and has been in the literature. An MIC less than 32 mcg/ml for fluconazole indicates a low likelihood of the presence of the erg11 gene which has been associated with azole resistance in C. auris. The detection of C. auris has significant infection prevention and control (IPC) implications. This is of importance in our healthcare system as unmonitored antifungal usage and a lack of surveillance can result in the further emergence of these potentially dangerous pathogens. This patient is for follow up at multiple healthcare facilities and so optimal IPC and surveillance are critical. Conclusion: The C. auris identified in our case was shown to be very sensitive in comparison to other healthcare facilities. None the less, its identification highlights the potential threat that this poses to IPC therefore the need for active surveillance.