Candida auris infection at a pediatric burn center: Treatment and infection control measures.

Objective: Candida auris (C. auris), a novel species, has been increasingly associated with hospital outbreaks worldwide in recent years. C. auris is regarded as a global health problem due to issues with the identification of C. auris, variable antifungal resistance profiles and the requirement for infection prevention and control (IPC) measures. With this study, we aimed to present our experience with two patients with C. auris fungemia who were referred to the Pediatric Burn Center of our hospital at different timepoints and share the antifungal treatment strategy and IPC management policies implemented in the clinic.

Methods: C. auris isolates were identified using MALDI-TOF MS (VITEK MS, bioMérieux, France). Antifungal susceptibility tests were performed at the Turkish Public Health Institution (THSK) using the broth microdilution (BMD) method. The BMD was carried out in accordance with the Clinical and Laboratory Standards Institute procedures.

Results: A patient (3-year-old girl) with C. auris which was identified at an external center and negative fungal screening results was transferred to our pediatric burn center. On the 41^st day of her hospitalization, she was diagnosed with catheter-related bloodstream infection (CRBSI) by C. auris. She received antifungal treatment for a total of 52 days, including caspofungin for 12 days, followed by micafungin for 40 days. Three months after the detection of the index case, a second patient (2-year-old girl) was diagnosed with CRBSI by C. auris on the 27^th day of hospitalization. This patient received antifungal treatment for a total of 42 days, including 30 days of combination therapy (liposomal amphotericin B and voriconazole). Immediately after the recognition of the index C. auris case, infection prevention and control (IPC) measures were formulated and implemented. IPC measures included strict isolation of the patient infected with C. auris, and screening of all other patients and the environment. C. auris was not detected in any of the patients screened. None of the environmental swabs tested positive for C. auris.

Conclusion: Collaboration between clinical microbiology laboratories and the IPC committee is essential for making correct and early diagnosis, optimizing the management of precautions and reducing the spread of infection in the hospital.