Candida auris in Greek healthcare facilities: Active surveillance results on first cases and outbreaks from eleven hospitals within Attica region

BACKGROUND

Candida auris was sporadically detected in Greece until 2019. Thereupon, there has been an increase in isolations among inpatients of healthcare facilities.

AIM

We aim to report active surveillance data on MALDI-TOF confirmed Candida auris cases and outbreaks, from November 2019 to September 2021.

METHODS

A retrospective study on hospital-based Candida auris data, over a 23-month period was conducted, involving 11 hospitals within Attica region. Antifungal susceptibility testing and genotyping were conducted. Case mortality and fatality rates were calculated and p-values less than 0.05 were considered statistically significant. Infection control measures were enforced and enhanced.

RESULTS

Twenty cases with invasive infection and 25 colonized were identified (median age: 72 years), all admitted to hospitals for reasons other than fungal infections. Median hospitalisation time until diagnosis was 26 days. Common risk factors among cases were the presence of indwelling devices (91.1 %), concurrent bacterial infections during hospitalisation (60.0 %), multiple antimicrobial drug treatment courses prior to hospitalisation (57.8 %), and admission in the ICU (44.4 %). Overall mortality rate was 53 %, after a median of 41.5 hospitalisation days. Resistance to fluconazole and amphotericin B was identified in 100 % and 3 % of tested clinical isolates, respectively. All isolates belonged to South Asian clade I. Outbreaks were identified in six hospitals, while remaining hospitals detected sporadic C. auris cases.

CONCLUSION

Candida auris has proven its ability to rapidly spread and persist among inpatients and environment of healthcare facilities. Surveillance focused on the presence of risk factors and local epidemiology, and implementation of strict infection control measures remain the most useful interventions.

Immunological and molecular detection of human immunodeficiency virus in saliva, and comparison with blood testing

In order to test the detection feasibility of human immunodeficiency virus (HIV) in saliva, a three-method blind screening analysis was conducted. Sixty-eight individuals were studied, comprising 34 HIV carriers and 34 noncarriers (controls) of matched gender and age. An oral examination preceded saliva and blood sampling of studied individuals. All samples were tested blind for HIV by using two immunological methods [Oraquick-compatible enzyme-linked immunosorbent assay (ELISA) and a fluorescent immunoenzymatic method (ELFA)], confirmed by western blotting, and a simple molecular method (polymerase chain reaction amplification of a relatively constant viral DNA region), confirmed by DNA hydridization. Compared with the controls, about twice as many HIV carriers had oral health problems, including periodontal disease. ELFA resulted in 33/34 positives and 34/34 negatives in saliva, while it detected 34/34 positives and 34/34 negatives in blood. ELISA performed even better, with correct assignment of all positives and negatives in both saliva and blood. The PCR method, at three annealing temperatures, surprisingly detected all positive samples, while it gave no false-positive result. In conclusion, the detection of anti-HIV in saliva may achieve accuracy of 97.1-100%, comparable with that in blood. Furthermore, this study suggests that a highly accurate molecular method of HIV detection may be feasible, although the studied carriers had rather homogeneous characteristics.