Changing trends in the sources and volumes of clinical cultures with Candida auris at an integrated health system in Miami, Florida, United States, 2019-2023

Abstract

Background: Candida auris (C auris) has rapidly spread in the United States. We aimed to characterize the trends in volumes and sources of clinical cultures with C auris at a large health care system.

Methods: We conducted a retrospective observational study including clinical cultures with C auris collected between April 1, 2019, and December 31, 2023. Surveillance cultures were excluded. Clinical specimens were processed through routine methods, and identification was performed using mass spectrometry. Whole-genome sequencing was performed on select specimens.

Results: We identified 327 clinical cultures belonging to 231 unique patients. The number of clinical cultures increased each year, from 5 in 2019 to 29 in 2020 (580%), 71 in 2021 (251% relative to 2020), 107 in 2022 (46% relative to 2021), and 115 in 2023 (7% relative to 2022). Blood cultures were the most common source, but specimens originating from soft tissue/bone infections had a large increase in 2022 and 2023. All sequenced isolates belong to clade III (South African clade) and were resistant to fluconazole and susceptible to echinocandins and amphotericin B.

Conclusions: The volumes of clinical cultures with C auris have rapidly increased, accompanied by an expansion in the sources of infection.

Keywords: Azoles; Candidemia; Resistance; Whole-genome sequencing.