Control of Candida auris in healthcare institutions: Outcome of an International Society for Antimicrobial Chemotherapy expert meeting

Kenters, Nikki; Kiernan, Martin; Chowdhary, Anuradha; Denning, David W.; Pemán, Javier; Saris, Katja; Schelenz, Silke; Tartari, Ermira; Widmer, Andreas F.; Meis, Jacques F.; Voß, Andreas

doi:10.1016/j.ijantimicag.2019.08.013

Cited by 77 publications

(104 citation statements)

References 67 publications

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“…The success of environmental decontamination was variable in the literature utilizing mostly materials and methods tested earlier against resistant Gram-positive and Gram-negative pathogens [17,21,38,39]. The use of high-concentration chlorine solutions in combination with hydrogen peroxide vapor or UV light for terminal decontamination has been suggested to be effective in controlling the transmission in some reports [17,19,21,40]. The same protocol without UV light was used in our setting twice including when it was used for controlling a MERS-CoV outbreak, but this failed to have impact on the incidence of new C. auris cases.…”

Section: Discussionmentioning

confidence: 99%

Ongoing Challenges with Healthcare-Associated Candida auris Outbreaks in Oman

Maani

Paul

Al-Rashdi

et al. 2019

JoF

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Candida auris has emerged in the past decade as a multi-drug resistant public health threat causing health care outbreaks. Here we report epidemiological, clinical, and microbiological investigations of a C. auris outbreak in a regional Omani hospital between April 2018 and April 2019. The outbreak started in the intensive care areas (intensive care unit (ICU), coronary care unit (CCU), and high dependency unit) but cases were subsequently diagnosed in other medical and surgical units. In addition to the patients' clinical and screening samples, environmental swabs from high touch areas and from the hands of 35 staff were collected. All the positive samples from patients and environmental screening were confirmed using MALDI-TOF, and additional ITS-rDNA sequencing was done for ten clinical and two environmental isolates. There were 32 patients positive for C. auris of which 14 (43.8%) had urinary tract infection, 11 (34.4%) had candidemia, and 7 (21.8%) had asymptomatic skin colonization. The median age was 64 years (14-88) with 17 (53.1%) male and 15 (46.9%) female patients. Prior to diagnosis, 21 (65.6%) had been admitted to the intensive care unit, and 11 (34.4%) had been nursed in medical or surgical wards. The crude mortality rate in our patient's cohort was 53.1. Two swabs collected from a ventilator in two different beds in the ICU were positive for C. auris. None of the health care worker samples were positive. Molecular typing showed that clinical and environmental isolates were genetically similar and all belonged to the South Asian C. auris clade I. Most isolates had non-susceptible fluconazole (100%) and amphotericin B (33%)

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Section: Discussionmentioning

confidence: 99%

Ongoing Challenges with Healthcare-Associated Candida auris Outbreaks in Oman

Maani

Paul

Al-Rashdi

et al. 2019

JoF

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“…Terminal cleaning and disinfection should be performed when the patient is moved from the care area permanently [40,47,49,61]. Chemical fogging, vaporized hydrogen peroxide, ozone, chlorine dioxide, and ultraviolet light, ionization, and titanium dioxide/ultraviolet light, might allow thorough disinfection of difficult-to-reach places, though further evaluations of these methods against C. auris are needed [40,47,49,61,62].…”

Section: Infection Control Practicesmentioning

confidence: 99%

Candida auris: A Review of Recommendations for Detection and Control in Healthcare Settings

Cáceres

Forsberg

Welsh

et al. 2019

JoF

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Candida auris is an emerging multidrug-resistant fungal pathogen. Since first reported in 2009, C. auris has caused healthcare outbreaks around the world, often involving high mortality. Identification of C. auris has been a major challenge as many common conventional laboratory methods cannot accurately detect it. Early detection and implementation of infection control practices can prevent its spread. The aim of this review is to describe recommendations for the detection and control of C. auris in healthcare settings. most common misidentifications based on frequently used yeast identification methods [5,6]. However, efforts to improve C. auris identification methods have made substantial progress in the last few years. The development of a high-salt, high-temperature enrichment culture-based method has made it possible to reliably isolate C. auris from complex sample types [7][8][9]. Once an isolate is obtained, identification of C. auris can be efficiently accomplished with matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. For MALDI-TOF identification, it is important to ensure C. auris is in the reference database [5,6,10]. The Bruker Biotyper (Bruker Daltonik GmbH, Bremen, Germany) and the VITEK MS (bioMérieux, Marcy, L'Etoile, France) include C. auris in their Research Use Only and certain versions of their FDA-approved system databases [3,5,11]. If MALDI-TOF is not available, laboratories can reliably identify an isolate by sequencing the D1-D2 region of the 28s rDNA or the internal transcribed spacer (ITS) regions of rDNA [12][13][14].

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“…Although Candida albicans has been mainly responsible for the majority of hospital‐acquired candidaemia cases, non‐ albicans Candida species, that is C. parapsilosis , C. glabrata , C. tropicalis , C. krusei and C. guilliermondii , currently constitute a large proportion of Candida ‐related infections . Notoriously, multidrug‐resistant Candida auris is increasingly being recognised as an emerging and serious clinical concern for human health, especially for hospitalised patients with serious underlying diseases . Strikingly, the shift from typical C. albicans infections towards various non‐ albicans Candida species is associated with increased mortality and reduced susceptibility to antifungal drugs.…”

Section: Introductionmentioning

confidence: 99%

“…Strikingly, the shift from typical C. albicans infections towards various non‐ albicans Candida species is associated with increased mortality and reduced susceptibility to antifungal drugs. Previous exposure to azoles and echinocandins for prophylaxis and treatment, respectively, might be an important factor contributing to the increase in candidiasis due to non‐ albicans Candida species . Morbidity and mortality attributed to Candida bloodstream infections in adults are higher than those in children, but poor prognosis has been reported among infants, children and elderly patients.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10] Notoriously, multidrug-resistant Candida auris is increasingly being recognised as an emerging and serious clinical concern for human health, especially for hospitalised patients with serious underlying diseases. 11 Strikingly, the shift from typical C. albicans infections towards various non-albicans Candida species is associated with increased mortality and reduced susceptibility to antifungal drugs. Previous exposure to azoles and echinocandins for prophylaxis and treatment, respectively, might be an important factor contributing to the increase in candidiasis due to non-albicans Candida species.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiological features of nosocomial candidaemia in neonates, infants and children: A multicentre study in Iran

Ahangarkani

Shokohi

Rezai

et al. 2020

Mycoses

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Summary Nosocomial bloodstream candidaemia is a life‐threatening fungal infection with high morbidity and mortality, especially among paediatric patients undergoing intensive immunosuppressive therapy. Limited data on the epidemiology of candidaemia and susceptibility profiles are available for Iran. To characterise candidaemia epidemiology, comorbidity risk factors, species distribution, and antifungal susceptibility profiles among paediatric patients in Iran. This observational cross‐sectional study enrolled 26 189 patients <18 years old at three reference paediatric hospitals in Mazandaran and Tehran over 2 years. Blood samples from patients with suspected fungal bloodstream infection were analysed using the BACTEC culture system. Fungal isolates were identified using matrix‐assisted laser desorption ionisation time‐of‐flight mass spectrometry (MALDI‐TOF) and DNA sequencing. Antifungal susceptibility testing was performed using the Clinical and Laboratory Standards Institute broth microdilution guideline. We observed 109 episodes of nosocomial candidaemia in paediatric patients with or without immunosuppressive therapy. The most common healthcare‐associated factor was central vascular catheter use (97%). The all‐cause mortality rate was 40%, of which 48% was attributable to candidaemia. While Candida albicans was the most frequent causative agent (49%), emerging and uncommon Candida species were also isolated. Candidaemia mortality by non‐albicans Candida species was significantly higher than that by C. albicans (P < .05). All fluconazole‐resistant species were non‐albicans Candida species. Uncommon Candida species with reduced susceptibility to antifungals are emerging as major agents of nosocomial candidaemia in high‐risk paediatric patients in Iran. Appropriate source control, antifungal regimens and improved antifungal stewardship are warranted for managing and decreasing the burden of nosocomial candidaemia.

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Control of Candida auris in healthcare institutions: Outcome of an International Society for Antimicrobial Chemotherapy expert meeting

Cited by 77 publications

References 67 publications

Ongoing Challenges with Healthcare-Associated Candida auris Outbreaks in Oman

Ongoing Challenges with Healthcare-Associated Candida auris Outbreaks in Oman

Candida auris: A Review of Recommendations for Detection and Control in Healthcare Settings

Epidemiological features of nosocomial candidaemia in neonates, infants and children: A multicentre study in Iran

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