SHM Converge Scientific Abstract ePoster Gallery-Multifactorial Acute Kidney Injury and Persistent Candida Auris Fungemia in a Pateint With Chronic Prosthetic Joint Infection: A Complex Case Report

Multifactorial Acute Kidney Injury and Persistent Candida Auris Fungemia in a Pateint With Chronic Prosthetic Joint Infection: A Complex Case Report

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This case report describes a 74-year-old woman with stage 3 chronic kidney disease, chronic right hip prosthetic joint infection, and multiple prior orthopedic surgeries who was admitted with altered mental status, acute kidney injury, and metabolic abnormalities. Her renal failure was likely multifactorial, including acute tubular necrosis, sepsis, and prior vancomycin exposure, and progressed to the point of requiring intermittent hemodialysis and then continuous renal replacement therapy.<br /><br />During hospitalization, blood cultures grew Candida auris, an emerging multidrug-resistant fungal pathogen known for high mortality, healthcare-associated spread, and limited treatment options. The suspected sources of infection were her infected hip prosthesis and a central venous catheter. The catheter was removed, and she was treated with micafungin along with broad-spectrum antibiotics. Despite this, her blood cultures remained persistently positive, raising concern for deep-seated infection and inadequate source control. A transesophageal echocardiogram did not show endocarditis.<br /><br />The case highlights the challenge of managing C. auris in patients with chronic kidney disease and prosthetic hardware. C. auris is often resistant to fluconazole and may show reduced susceptibility to echinocandins, making therapy difficult. Prosthetic joint infections are especially hard to eradicate because of biofilm formation and the frequent need for surgical intervention. Persistent fungemia after appropriate antifungal treatment should prompt evaluation for infected hardware or other hidden sources.<br /><br />The report emphasizes the importance of early recognition, rapid diagnostic methods when available, aggressive source control, multidisciplinary care, and strict infection prevention measures to reduce both mortality and transmission.

Asset Subtitle

Jonathan D. Grube

Meta Tag

Author List Damanpartap Singh Sandhu, Enrique Valdez Saenz, Jonathan D. Grube, Kathleen Mattingly, Kenneth Hackbarth, Patrick Vickers, Sage Ben David, Sai Varun Gadde

Category Clinical Vignettes

Concept Candida auris

Concept Multidrug Resistance

Concept Fungemia

Concept Mortality Risk

Concept Blood Culture

Distinguished Non-Finalist

Presenter Organization UCF/HCA Ocala Internal Medicine Residency

Presenting Author Jonathan D. Grube

Track Adult

Keywords

Candida auris

fungemia

chronic kidney disease

prosthetic joint infection

micafungin

hemodialysis

continuous renal replacement therapy

sepsis

biofilm infection

source control

Candida auris

Multidrug Resistance

Fungemia

Mortality Risk

Blood Culture