Early Detection and Quick Infection Prevention Support Key to Tackling Candida Auris

Candida auris is an emerging scourge in healthcare facilities, including long-term acute care hospitals (LTACHs) and skilled nursing facilities with ventilator units (VSNFs). Patients in either of these facilities are at risk for C auris colonization, which can lead to invasive disease in 5-10% of patients and carry a mortality rate of >45%.

An LTACH-affiliated laboratory in California began enhanced surveillance of C auris in September 2018 to monitor rates of colonization and transmission. In February 2019, a case was identified in Orange County in a patient who had not traveled outside the region, indicating local acquisition.

An interdisciplinary team from US Centers for Disease Control and Prevention, California Department of Public Health, and Orange County Health Care Agency performed point prevalence surveys (PPS) and infection prevention assessments at all LTACH and VSNF subacute units in Orange County to record all C auris colonization and control the spread of the emerging pathogen.

The team’s findings were presented at IDWeek 2019.

Investigators collected composite axilla and groin swabs for C auris polymerase chain reaction testing and reflex culture from all assenting patients at facilities between March and August 2019 and performed PPS. Facilities with >1 C auris-colonized patient received a repeat PPS every 2 weeks to monitor new transmissions. The research team used whole-genome sequencing to evaluate the relationships of isolates and also analyzed infection prevention measures such as hand hygiene adherence, access to alcohol-based hand rubs, and cleaning of high-touch surfaces.

The first PPS included 3 Orange County LTACHs and 14 VSNFs. A total of 45 C auris-colonized patients were reported in 3 (100%) LTACHs and 6 (43%) VSNFs. That number increased to 124 colonized patients in the repeat PPS. Most of the patients (70%) were at 2 facilities.

Investigators completed whole-genome sequencing for isolates from 48 patients, which revealed that all of the samples were highly related (< 11 single nucleotide polymorphisms) in the African clade.

When it came to infection prevention measures, 5 of the 9 facilities with C auris displayed hand hygiene adherence < 50%, 3 had limited access to alcohol-based hand rubs, and < 60% of assessed high-touch surfaces were clean.

“Our investigation, prompted by enhanced surveillance, identified C auris at 9 [Orange County] facilities. [Whole-genome sequencing] indicated a single introduction and local transmission,” investigators concluded. “Early detection, followed by rapid county-wide investigation and [infection preventionist] support, enabled containment efforts for C auris in [Orange County].”

The study, Regional assessment and containment of Candida auris transmission in post-acute care settings - Orange County, California, 2019, was presented as a late breaking oral abstract on Thursday, October 3, 2019, at IDWeek in Washington, DC.