Candida auris cluster in a large third level Italian hospital: a case series

Objectives: Candida auris has been circulating since 2019 in Northern and Middle-Italy regions. Design: This report details the first three cases of C. auris isolation in Puglia (Southern Italy), which occurred as a nosocomial outbreak. Results: The first C. auris specimen was isolated on April 19, 2024 from a blood culture obtained from a 55year-old male (GM) in an intensive care unit (ICU) of Bari Policlinico General Hospital. The patient had been admitted on April 06, 2024 due to subarachnoid hemorrhage. On April 12, 2024, a blood sample tested positive for multidrug-resistant Klebsiella pneumoniae , requiring isolation and wide-spectrum antibiotic therapy. Exitus occurred on April 17, 2024, but 2 days later, a pre-mortem blood sample tested positive for C. auris , leading to epidemiologic investigation in the whole ICU. A second case was therefore identified (SD), a 36-year-old male admitted on March 21, 2024, shortly after undergoing a dental procedure in Tirana (Albania). Due to the timing of admission, he was identified as the index case. A third case was later found on April 29, 2024 (CM), a 52-year-old woman with a history of acute myeloid leukemia located in the same ICU but on a different floor. A link of transmission was identified via environmental sampling, as the medics' common telephone tested positive for C. auris contamination. Conclusion: The pathogen's circulation has shown to be inapparent and difficult to track, making it a potential threat even for facilities outside of known high-risk geographical areas. ICUs should be monitored routinely.