First report of Candida auris in America: Clinical and microbiological aspects of 18 episodes of candidemia Q7 Q6 Belinda Calvo a , Analy Salles de Azevedo Melo b , Armindo Perozo-Mena c , Martin Hernandez d , Elaine Cristina Francisco b , Ferry Hagen e,f , Jacques F. Meis e,f , Arnaldo Lopes Colombo b, * a Departamento de Enfermedades Infecciosas y Tropicales, Escuela de Medicina, Universidad del Zulia, Maracaibo, Venezuela b Laborat  orio Especial de Micologia, Escola Paulista de Medicina, UNIFESP, S ~ ao Paulo, Brazil c Centro de Referencia Bacteriol  ogica del Servicio Aut  onomo Hospital Universitario de Maracaibo, Venezuela d Servicio de Medicina Interna de Servicio Aut  onomo Hospital Universit  ario de Maracaibo, Venezuela e Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands f Radboudumc/CWZ Centre of Excellence in Mycology, Nijmegen, The Netherlands Accepted 9 July 2016 Available online --- KEYWORDS Candida auris; Candidemia; Fluconazole resistance; Neonatal intensive care; Outbreak; Fingerprinting; Amplified fragment length polymorphism; Venezuela Summary Objectives: Characterization of a hospital outbreak of Candida auris candidemia that involved 18 critically ill patients in Venezuela. Method: Bloodstream isolates of C. auris obtained from 18 patients admitted at a medical center in Maracaibo, between March, 2012 and July, 2013 were included. Species identification was confirmed by ITS rDNA sequencing. Isolates were subsequently typed by amplified frag- ment length polymorphism fingerprinting (AFLP). Susceptibility testing was performed accord- ing to CLSI. Clinical data were collected from all cases by using a standard clinical form. Results: A total of 13 critically ill pediatric and 5 adult patients, with a median age of 26 days, were included. All were previously exposed to antibiotics and multiple invasive medical proce- dures. Clinical management included prompt catheter removal and antifungal therapy. Thirteen patients (72%) survived up to 30 days after onset of candidemia. AFLP fingerprinting of all C. auris * Corresponding author. Rua Pedro de Toledo, 669 e 5  andar, CEP 04039-032, Sao Paulo, SP, Brazil. E-mail addresses: bcalvom@yahoo.es (B. Calvo), analysalles@gmail.com (A. Salles de Azevedo Melo), aperozomena@gmail.com (A. Perozo-Mena), martinhernandezart2@yahoo.es (M. Hernandez), elaineperol@yahoo.com.br (E.C. Francisco), f.hagen@gmail. com (F. Hagen), jacques.meis@gmail.com (J.F. Meis), colomboal@terra.com.br (A.L. Colombo). http://dx.doi.org/10.1016/j.jinf.2016.07.008 0163-4453/ª 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved. www.elsevierhealth.com/journals/jinf Journal of Infection (2016) xx,1e6 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 YJINF3782_proof ■ 25 July 2016 ■ 1/6 Please cite this article in press as: Calvo B, et al., First report of Candida auris in America: Clinical and microbiological aspects of 18 episodes of candidemia, J Infect (2016), http://dx.doi.org/10.1016/j.jinf.2016.07.008