title: Nosocomial fungemia by Candida auris: First four reported cases in continental Europe.
abstract: BACKGROUND
  Candida auris is an emerging multidrug-resistant yeast that can cause invasive infections and is associated with high mortality. It is typically resistant to fluconazole and voriconazole and, some cases, also to echinocandins and amphotericin B. This species, phylogenetically related to Candida haemulonii, is frequently misidentified by commercial identification techniques in clinical laboratories; therefore, the real prevalence of C. auris infections may be underestimated.
  
  
  OBJECTIVE
  To describe the clinical and microbiological features of the first four cases of C. auris fungemia episodes observed in the European continent.
  
  
  METHODS
  The four patients were hospitalized in the adult surgical intensive care unit. A total of 8 isolates (two per patient) from blood and catheter tip were analyzed.
  
  
  RESULTS
  All isolates were misidentified as Saccharomyces cerevisiae by AuxaColor 2, and as Candida sake by API ID20C. VITEK MS technology misidentified one isolate as Candida lusitaniae, another as C. haemulonii and could not identify the other six. C. auris identification was confirmed by ITS rDNA sequencing. All isolates were fluconazole (MIC >256mg/l) and voriconazole (MIC 2mg/l) resistant and susceptible to posaconazole, itraconazole, echinocandins and amphotericin B.
  
  
  CONCLUSIONS
  C. auris should be regarded as an emerging pathogen, which requires molecular methods for definitive identification. Our isolates were highly resistant to fluconazole and resistant to voriconazole, but susceptible to the other antifungals tested, which emphasizes the importance of accurately identifying this species to avoid therapeutic failures.
authors.affiliation: Severe Infection Research Group, Health Research Institute La Fe, Valencia, Spain.
authors.forename: Alba Cecilia
authors.initials: AC
authors.lastname: Ruiz Gaitán
authors.affiliation: Anesthesiology and Surgical Critical Care Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Moret
authors.affiliation: Microbiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: López Hontangas
authors.affiliation: Microbiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Molina
authors.affiliation: Anesthesiology and Surgical Critical Care Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: Aleixandre López
authors.affiliation: Microbiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Alicia Hernández
authors.initials: AH
authors.lastname: Cabezas
authors.affiliation: Preventive Medicine Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Mollar Maseres
authors.affiliation: Microbiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Rabat Chouman
authors.initials: RC
authors.lastname: Arcas
authors.affiliation: Microbiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Gómez Ruiz
authors.affiliation: Anesthesiology and Surgical Critical Care Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Chiveli
authors.affiliation: Severe Infection Research Group, Health Research Institute La Fe, Valencia, Spain.
authors.forename: Emilia
authors.initials: E
authors.lastname: Cantón
authors.affiliation: Severe Infection Research Group, Health Research Institute La Fe, Valencia, Spain; Microbiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain. Electronic address: javier.peman@gmail.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Pemán
mesh_terms: D000328:Adult; D002175:Candida / Q000302:isolation & purification*; D058387:Candidemia / Q000382:microbiology*; D003428:Cross Infection / Q000382:microbiology*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Candida auris; Candidemia; Cuidados intensivos quirúrgicos; Fluconazole resistance; Fungemia; Resistencia al fluconazol; Surgical intensive care