A case developing Candida auris related candidaemia following multiple drug-resistant Klebsiella pneumoniae meningitis after neurosurgical intervention

A 28-year-old man who underwent ventriculoperitoneal shunt (VPS) operation at another medical center due to epidural abscess and hydrocephalus was admitted due to deterioration of his general condition. WBC count was 9360/mm³, C-reactive protein (CRP) was 54 mg/L (normal range <5 mg/L) and glomerular filtration rate was 150 ml/min, while the results of other laboratory tests were nonspecific. He was receiving vancomycin and meropenem treatment. Urine cultures were taken during hospitalization and again 48 hours later and Candida auris (C. auris) growth of 105 cfu/ml was detected. On the 4th day of hospitalization, the patient was intubated due to decreased oxygen saturation, and while under meropenem and vancomycin treatment, carbapenem-resistant, gentamicin and ceftazidime-avibactam-susceptible and multidrug-resistant Klebsiella pneumoniae growth was detected in CSF culture. The patient's ventriculoperitoneal shunt was removed and hydrocephalus was followed with extra-ventricular drainage (EVD). Vancomycin treatment was discontinued and intrathecal (IT) gentamicin treatment was started. Due to the susceptibility of Klebsiella pneumoniae growth from deep tracheal aspirate to ceftazidime-avibactam, antibiotic treatment was changed to intravenous (IV) meropenem, IV ceftazidime-avibactam and IT gentamicin and treatment was continued for 10 days. No growth was detected in CSF culture obtained under treatment. On the 20th day of hospitalization due to deterioration of his clinical condition under treatment, tracheostomy was performed, he was intubated, blood and urine cultures were repeated and C. auris growth was detected in blood culture on the 27th day after hospitalization using VITEK MS MALDITOF (bioMérieux, France) microbiological identification system. Confirmation of the C. auris species and antifungal susceptibility testing was performed by the Mycology Reference Laboratory, Institute of Public Health and antibiotic treatment was stopped. According to the antifungal susceptibility test results, the patient was started on anidulafungin. In conclusion, nosocomial C. auris infection should be considered in patients with underlying predisposing factors such as long intensive care unit stays, broad-spectrum antibiotic use, surgical interventions, central venous catheter use, intubation and infection due to gram-negative bacteria.