Abstract
Background
Candida auris (reclassified as Candidozyma auris) is an emerging multidrug-resistant fungal pathogen associated with healthcare-associated outbreaks. Its persistence in healthcare environments and frequent misidentification pose challenges for infection prevention. This study aimed to estimate ICU colonisation prevalence, reassess non-albicans Candida (NAC) isolates using molecular diagnostics, and conduct targeted ward surveillance.Methods
A prospective surveillance study was conducted from September 2022 to December 2023 across six ICUs of a tertiary care hospital in Jammu & Kashmir. Monthly axilla-groin composite swabs were collected, with rescreening of patients remaining admitted during subsequent rounds. Targeted surveillance was undertaken in wards where C. auris was recovered from sterile-site specimen. Identification used HiCrome Candida differential agar (HCDA), VITEK® 2 Compact, and species-specific PCR. Antifungal susceptibility testing (AFST) was performed by E-test.Results
Twenty unique patients were colonised with C. auris, giving an overall ICU colonisation prevalence of 4.1%. Ten additional unique patients were identified through targeted surveillance and were not included in the ICU denominator. Thus, 30 unique patients were identified. Of 120 non-albicans Candida isolates, PCR confirmed 54 C. auris, including eight misidentified by VITEK 2. All isolates met the CDC tentative resistance threshold for fluconazole, while no echinocandin resistance was detected. Amphotericin B resistance occurred in 4/54 (7.4%) isolates. Voriconazole MICs >32 μg/mL occurred in 7/54 (13.0%) isolates and were reported descriptively. Sixteen (53.3%) patients with C. auris expired.Conclusion
Fifteen-month surveillance identified ICU colonisation and highlighted limitations of phenotypic identification. Molecular confirmation and continued surveillance are important for early recognition of C. auris and infection control.