Prevalence, pattern of disease and antimicrobial susceptibility of Candidozyma auris in the greater Pretoria region from 2021 to 2024.

BACKGROUND

Candidozyma auris has emerged as a nosocomial pathogen in South Africa, characterised by multidrug resistance and environmental persistence.

OBJECTIVES

This study aimed to describe the prevalence, disease patterns, and antifungal susceptibility patterns of C. auris isolates recovered from public-sector healthcare facilities in the greater Pretoria region from 2021 to 2024.

METHOD: A retrospective laboratory-based surveillance study was conducted using data from the National Health Laboratory Service Tshwane Academic Division laboratory. Isolates were classified as invasive or non-invasive based on specimen source. Temporal trends in antifungal minimum inhibitory concentrations (MICs) were analysed using interval-censored regression.

RESULTS

A total of 592 C. auris isolates were identified. Blood cultures were the most frequent specimen source overall, comprising 237 isolates (40.03%). Intravascular catheter tip isolates predominated in 2023 and 2024, with 48 and 72 isolates, respectively. The proportion of invasive isolates declined from 56.8% to 40.8% over the study period. Among tested isolates, fluconazole resistance exceeded 99%. Resistance to amphotericin B and echinocandins was uncommon, with eight total isolates identified. Decreasing MIC trends were observed for amphotericin B (β = -0.059 per year; p = 0.012) and micafungin (β = -0.081 per year; p = 0.026).

CONCLUSION

Candidozyma auris remains established in the public-sector within the greater Pretoria region. There is a shift from invasive bloodstream infections towards non-invasive, device-associated isolates. Fluconazole resistance remained high while amphotericin B and echinocandins retained good in vitro activity.

CONTRIBUTION: This study contributes to the knowledge of C. auris in the greater Pretoria region, providing insight into epidemiology and antifungal susceptibility.