@article{c2f9864528e3464fa036ba4d26293859,
title = "Outbreak investigation of Candida auris at a tertiary care hospital in Karachi, Pakistan",
abstract = "Background: From September 2014, a tertiary care hospital in Karachi, Pakistan, started diagnosing 3–5 cases/month of a yeast locally identified as Saccharomyces spp. resistant to fluconazole. US Centers for Disease Control and Prevention identified the isolates as Candida auris. The Pakistan Field Epidemiology and Laboratory Training Program (FELTP) and the hospital investigated the outbreak from April 2015 to January 2016. Objective: The aim of the outbreak investigation was to determine the risk factors and to inform measures to limit the spread of the organism in the hospital. Methods: Medical records, nursing schedules and infection control practices were reviewed. Sixty-two age- and sex-matched hospital controls from the same wards were identified. Results: Thirty cases (17 males) were identified (mean age = 51.6 years, age range = 2–91 years), case fatality was 53%. Multivariate logistic regression showed that a history of surgery within 90 days of diagnosis, admission to the emergency department and history of chronic kidney disease were significantly associated with C. auris infection. Discussion: This is the report of the outbreak investigation that triggered a global exploration of C. auris as a newly identified multidrug-resistant nosocomial organism, spreading within the hospital, especially among patients with invasive procedures. Unfortunately, we could not identify any specific source of the outbreak nor stop the transmission of the organism.",
keywords = "Candida auris, fluconazole resistant, infection control, outbreak investigation",
author = "Farooqi, {Joveria Q.} and Soomro, {Asad S.} and Baig, {Mirza A.} and Sajjad, {Shamoona F.} and Kamran Hamid and Kauser Jabeen and Naqvi, {Mohammed F.} and Nosheen Nasir and Rozina Roshan and Mahmood, {Syed F.} and Afia Zafar and Asghar, {Rana J.}",
note = "Funding Information: From our University Hospital: Mycology bench technologists Samia Tariq, Sidra Laiq and Kanwal Iqbal for their vigilance in identifying suspected cases and keeping the investigation team informed. Microbiology post-graduate residents and Infectious Diseases fellows Salima Qamar, Fizza Farooqui, Pushpa Bhawan Mal, Yusra Shafquat and Aneela Hussain were extremely helpful in reviewing patient files for both cases and controls with the investigation team and rechecking the data entered in the case report forms and datasheets. We would also like to thank the Health Information Management Department, Nutrition and Food Services Department, Pharmacy Department and all hospital nursing and administrative staff for their utmost cooperation during the investigation. From CDC: The strain confirmation would not have been possible without the support and guidance of our collaborators, specifically those involved in the C. auris working group: Shawn Lockhart, Snigdha Vallabhaneni at the Mycotic Diseases Branch, CDC, both the current and the prior Branch Chiefs, Dr Tom Chiller and Dr Mary E Brandt, in laboratory identification and confirmation, and epidemiological investigation The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Some of the bench work, related to antifungal susceptibility testing, and the shipment of isolates to CDC, Atlanta, were supported by HEC, US Bio-Engagement Program, USAID and Ministry of Science and Technology, grant no. 4-338/PAK-US/HEC/2010/932. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Some of the bench work, related to antifungal susceptibility testing, and the shipment of isolates to CDC, Atlanta, were supported by HEC, US Bio-Engagement Program, USAID and Ministry of Science and Technology, grant no. 4-338/PAK-US/HEC/2010/932. Publisher Copyright: {\textcopyright} The Author(s) 2020.",
year = "2020",
month = sep,
day = "1",
doi = "10.1177/1757177420935639",
language = "English",
volume = "21",
pages = "189--195",
journal = "Journal of Infection Prevention",
issn = "1757-1774",
publisher = "SAGE Publications Ltd",
number = "5",
}
