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Open AccessArticle

Ongoing Challenges with Healthcare-Associated Candida auris Outbreaks in Oman

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Directorate General for Disease Surveillance and Control (DGDSC), Ministry of Health, 393 Muscat, Oman
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Department of Infection Prevention and Control, DGDSC, Ministry of Health, 393 Muscat, Oman
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Central Public Health Laboratories, DGDSC, Ministry of Health, 393 Muscat, Oman
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Infection Prevention and Control Department, Sohar Hospital, Ministry of Health, 749 Sohar, Oman
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Paediatric Infectious Diseases Unit, Sohar Hospital, Ministry of Health, 749 Sohar, Oman
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Department of Diseases Surveillance and Control, Directorate General of Health Services, North Batinah Governorate, Ministry of Health, 749 Sohar, Oman
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Microbiology Section, Pathology Department, Sohar Hospital, 749 Sohar, Oman
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Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, 56 Mansoura, Egypt
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Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
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Centre of Expertise in Mycology Radboud University Medical Centre/Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
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Westerdijk Fungal Biodiversity Institute, 85167 Utrecht, The Netherlands
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Ministry of Health, Directorate General of Health Services, Al-Dhahirah Governorate, 46 Ibri, Oman
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Authors to whom correspondence should be addressed.
J. Fungi 2019, 5(4), 101; https://doi.org/10.3390/jof5040101
Received: 2 September 2019 / Revised: 5 October 2019 / Accepted: 14 October 2019 / Published: 23 October 2019
(This article belongs to the Special Issue Candida auris)
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 clade 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. View Full-Text
Keywords: Candida auris; infection; outbreak; Sohar Hospital; Oman Candida auris; infection; outbreak; Sohar Hospital; Oman
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Al Maani, A.; Paul, H.; Al-Rashdi, A.; Al Wahaibi, A.; Al-Jardani, A.; Al Abri, A.M.A.; AlBalushi, M.A.H.; Al Abri, S.; Al Reesi, M.; Al Maqbali, A.; Al Kasaby, N.M.; de Groot, T.; F. Meis, J.; Al-Hatmi, A.M.S. Ongoing Challenges with Healthcare-Associated Candida auris Outbreaks in Oman. J. Fungi 2019, 5, 101.

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