First cases and risk factors of super yeast Candida auris infection or colonization from Shenyang, China

Figures & data

Fig. 1 Onset chart of Candida auris infection.

Onset chart of 15 cases of Candida auris infection (the detection time and sample type are shown in the textboxes); Respiratory ICU inpatient number (RICU1-RICU8); Neurology ICU inpatient number (NICU1–NICU6); Neurosurgical ICU inpatient number (NSICU1); sp sputum; ur urine; bl blood; ca^a central venous line; ca^b urinary catheter; dr drainage

Fig. 2 Phylogenetic relationships of Candida auris strains isolated in Shenyang, China, compared with reference strains.

Phylogenetic trees were generated from the internal transcribed spacer (a) region and D1/D2 domain of the ribosomal DNA large subunit sequences (b). The percentage of replicate trees in which the associated taxa clustered together in the bootstrap test (1000 replicates) is shown next to each branch. Bold indicates strains from China. GenBank accession numbers are provided in parentheses. Scale bar indicates nucleotide substitutions per site

Information and susceptibility test of 15 isolates from 15 patients, Shenyang, China

Isolate	Age y	Sex	Source	MIC (μg/ml)
				AMB	5-FC	FZ	IZ	VOR	PZ	CAS	MF	AND
6258	─	─	─	0.5	4	32	0.12	0.25	0.25	0.25	0.12	0.03
RICU1	70	M	Urine	0.5	<0.06	256	0.06	0.5	0.03	0.06	0.06	0.12
RICU2	69	F	Urine	0.5	<0.06	256	0.12	1	0.06	0.12	0.12	0.12
RICU3	69	F	Sputum	0.5	<0.06	256	0.06	0.5	0.03	0.06	0.06	0.12
RICU4	56	M	blood	0.5	<0.06	256	0.12	1	0.06	0.12	0.12	0.12
RICU5	82	F	Catheter	0.5	< 0.06	256	0.06	0.5	0.03	0.12	0.12	0.12
RICU6	70	M	Catheter	0.5	<0.06	128	0.12	0.5	0.03	0.12	0.12	0.12
RICU7	63	F	Urine	0.5	<0.06	256	0.12	1	0.06	0.12	0.12	0.12
RICU8	73	F	Urine	0.5	<0.06	256	0.06	0.5	0.03	0.06	0.06	0.12
NICU1	60	F	Urine	0.5	<0.06	256	0.06	0.5	0.03	0.06	0.06	0.12
NICU2	58	M	Urine	1	<0.06	256	0.12	1	0.06	0.12	0.12	0.12
NICU3	86	M	Urine	0.5	<0.06	256	0.12	0.5	0.06	0.12	0.12	0.12
NICU4	49	M	Urine	0.5	<0.06	256	0.12	1	0.06	0.12	0.12	0.12
NICU5	86	F	Urine	0.5	<0.06	256	0.06	0.5	0.03	0.06	0.06	0.12
NICU6	82	F	Drainage	0.5	<0.06	256	0.06	0.5	0.03	0.06	0.06	0.12
NSICU1	53	M	Urine	0.5	<0.06	256	0.06	0.5	0.03	0.06	0.06	0.12

AMB amphotericin B, 5-FC flucytosine, FZ fluconazole, IZ itraconazole, VOR voriconazole, PZ posaconazole; CAS caspofungin, MF micafungin, AND anidulafungin

Fig. 3 Detection time and antifungal treatment process for all candida isolates of the first patient presenting with Candida auris infection (RICU1) during hospitalization.

This patient was treated with voriconazole (VOR 400 mg/day) for 7 days; fluconazole (FLU 400 mg/day) for 12 days; caspofungin (CAS 50 mg/day) for 10 days; and micafungin (MF 100 mg/day) for 14 days. Sp sputum; ur urine; bl blood; ca urinary catheter

Univariate risk factor analysis of Candida auris infection cases vs. controls

Parameter	Cases (n = 15)	Controls (n = 30)	P	OR (95% CI)
Age (years)	68.0 ± 11.9	68.6 ± 15.6	0.71
Hospital length of stay prior to infection	40.4 ± 33.4	26.9 ± 22.0	0.11
ICU length of stay prior to infection	31.9 ± 28.5	24.1 ± 21.1	0.22
APACHEII score on ICU admission	15.9 ± 6.2	14.9 ± 6.8	0.538
Male	8 (53)	22 (73)	0.18	0.42 (0.11–1.52)
prognosis	6 (40)	4 (13)	0.04	4.33 (0.99–18.94)
Heart dysfunction	3 (20)	6 (20)	1.00	1.00 (0.21–4.71)
pulmonary embolism	0 (0)	3 (10)	0.21	0.90 (0.80–1.01)
pneumonia	10 (67)	23 (77)	0.48	0.61 (0.16–2.39)
Lung dysfunction	9 (60)	15 (50)	0.53	1.50 (0.43–5.27)
Malignancy	3 (20)	6 (20)	1.00	1.00 (0.21–4.71)
Diabetes mellitus	7 (47)	8 (27)	0.18	2.41 (0.66–8.81)
Chronic renal failure/hemodialysis	2 (13)	5 (17)	0.77	0.77 (0.13–4.52)
Liver dysfunction	4 (27)	2 (7)	0.06	5.09 (0.81–31.9)
Thyroid	3 (20)	0 (0)	0.01	1.25 (0.97–1.61)
Abdominal	1 (7)	0 (0)	0.15	1.07 (0.94–1.23)
Rheumatic diseases	1 (7)	1 (3)	0.61	2.07 (0.12–35.61)
central nervous system	10 (67)	19 (63)	0.83	1.16 (0.31–4.27)
Prior surgery	5 (33)	4 (13)	0.11	3.25 (0.72–14.62)
Trauma	0 (0)	2 (7)	0.31	0.93 (0.85–1.03)
Previous hospitalization	4 (27)	2 (7)	0.06	5.09 (0.81–31.9)
Abdominal drainage	3 (20)	1 (3)	0.06	7.25 (0.68–76.87)
Diarrhea	7 (47)	2 (7)	0.00	12.25 (2.11–70.99)
Mechanical ventilation	14 (93)	24 (80)	0.25	3.5 (0.38–32.14)
Central venous line	8 (53)	14 (47)	0.67	1.31 (0.38–4.52)
Arterial line	7 (47)	10 (33)	0.38	1.75 (0.49–6.21)
Urinary catheter (Foley)	15 (100)	27 (90)	0.21	0.9 (0.8–1.01)
Trachea intubation	10 (67)	17 (57)	0.52	1.53 (0.42–5.58)
Tracheostomy	7 (47)	7 (23)	0.11	2.88 (0.77–10.77)
Gastrostomy	15 (100)	28 (93)	0.31	0.93 (0.85–1.03)
Colostomy	2 (13)	2 (7)	0.46	2.15 (0.27–17.03)
Parenteral feeding	6 (40)	16 (53)	0.40	0.58 (0.17–2.05)
Bladder irrigation	0 (0)	2 (7)	0.31	0.93 (0.85–1.03)
Gastrointestinal decompression	6 (40)	1 (3)	0.00	19.33 (2.05–182.55)
Steroid treatment	5 (33)	11 (37)	0.83	0.86 (0.28–3.19)
Antineoplastic chemotherapy	1 (7)	0 (0)	0.15	1.07 (0.94–1.23)
Candida albicans	5 (33)	2 (7)	0.02	7.00 (1.17–42.00)
Candida krusei	1 (7)	0 (0)	0.15	1.07 (0.94–1.23)
Candida tropicalis	4 (27)	3 (10)	0.15	3.27 (0.63–17.09)
Candida glabrate	4 (27)	3 (10)	0.15	3.27 (0.63–17.09)
Other candida	9 (60)	7 (23)	0.02	4.93 (1.30–18.73)
Fluconazole	6 (40)	8 (27)	0.36	1.83 (0.49–6.81)
Voriconazole	2 (13)	0 (0)	0.04	1.15 (0.95–1.41)
Caspofungin	2 (13)	3 (10)	0.74	1.39 (0.21–9.33)
Micafungin	3 (20)	2 (7)	0.18	3.50 (0.52–23.70)
Antipseudomonal penicillins	7 (47)	8 (27)	0.18	2.41 (0.66–8.81)
Second-generation cephalosporins	1 (7)	5 (17)	0.35	0.36 (0.04–3.37)
Third-generation cephalosporins	12 (80)	21 (70)	0.48	1.71 (0.39–7.58)
Fluoroquinolones	7 (47)	16 (63)	0.67	0.77 (0.22–2.65)
Linezolid	3 (20)	3 (10)	0.35	2.25 (0.40–12.80)
Glycopeptides	4 (27)	5 (17)	0.43	1.82 (0.41–8.10)
Carbapenems	12 (80)	24 (80)	1.00	1.00 (0.21–4.71)
Tetracyclines	7 (47)	1 (3)	0.00	25.38 (2.71–237.6)