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Please use this identifier to cite or link to this item: http://arks.princeton.edu/ark:/88435/dsp016w924g126
Title: Global Estimates of Candida auris: A Bayesian Analysis of Environmental Predictors of Spread
Authors: Kumar, Chirag
Advisors: Laxminarayan, Ramanan
Department: 
Certificate Program: Global Health and Health Policy Program
Class Year: 2023
Abstract: Candida auris (C. auris) is a multidrug resistant, nosocomial fungus that has caused significant outbreaks on all continents. Although numerous case studies have attempted to identify predictors and drivers of C. auris transmission, none have conclusively identified factors that may contribute to spread, and many hypotheses exist surrounding the environmental predictors of C. auris spread. In this work, I aggregated a global database of C. auris outbreaks through an extensive literature search and developed a hierarchical Bayesian regression to estimate C. auris cases from environmental and country-level variables (R\(^{2}\) = 99.8%). After controlling for numerous fixed-effects, C. auris cases are positively predicted by temperature (p = 0.01) and antifungal use (p < 0.01). However, I find a negative relationship between humidity and cases (p = 0.03). Collectively, this provides the first-ever evidence that C. auris transmission may be related to climate change and that there is a distinct ecological niche of C. auris spread. Reporting probabilities vary widely by income category with lower-middle income countries having an approximately 30% lower chance that a case is reported than upper-middle and high-income countries. Using this model, I provide global projections of C. auris cases both currently and under future climate/antifungal use scenarios. I identify the Mediterranean and lower-middle income countries across North Africa and South-East Asia (India, Pakistan) as having the highest current burden of cases, with that burden likely to also spread to Australia and Latin America (Brazil, Argentina). I conduct a factorial analysis to understand what variables may most impact future cases: increases in antifungal use dominate compared to the impacts of temperature and humidity, suggesting that future outbreaks of C. auris may be preventable with effective antimicrobial stewardship.
URI: http://arks.princeton.edu/ark:/88435/dsp016w924g126
Type of Material: Princeton University Senior Theses
Language: en
Appears in Collections:Global Health and Health Policy Program, 2017-2023

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