Candida aurisin Healthcare Facilities, New York, USA, 2013–2017

Abstract

Candida auris is an emerging yeast that causes healthcare-associated infections. It can be misidentified by laboratories and often is resistant to antifungal medications. We describe an outbreak of C. auris infections in healthcare facilities in New York City, New York, USA. The investigation included laboratory surveillance, record reviews, site visits, contact tracing with cultures, and environmental sampling. We identified 51 clinical case-patients and 61 screening case-patients. Epidemiologic links indicated a large, interconnected web of affected healthcare facilities throughout New York City. Of the 51 clinical case-patients, 23 (45%) died within 90 days and isolates were resistant to fluconazole for 50 (98%). Of screening cultures performed for 572 persons (1,136 total cultures), results were C. auris positive for 61 (11%) persons. Environmental cultures were positive for samples from 15 of 20 facilities. Colonization was frequently identified during contact investigations; environmental contamination was also common.

New and emerging infectious diseases (Ebola, Middle Eastern respiratory syndrome coronavirus, carbapenem-resistant Enterobacteriaceae, Candida auris): Focus on environmental survival and germicide susceptibility

“…127 C auris most commonly has been misidentified as C haemulonii, but also as C famata, C sake, Rhodotorula glutinis, R mucilaginosa, and Saccharomyces boulardii. 127,137,138 Currently, accurate identification of C auris can be accomplished by the use of MALDI-TOF or PCR assays specific for C auris. Multiple virulence factors have been described.…”

Diagnosis, management and prevention of Candida auris in hospitals: position statement of the Australasian Society for Infectious Diseases

“…Moreover, 25% were ‘resistant’ to two or more drug classes, and 13% were multi‐azole ‘resistant’ . Similarly, in New York, 98% of isolates were ‘resistant’ to fluconazole, and 25% ‘resistant’ to both fluconazole and amphotericin B . In Spain, all isolates were fluconazole‐ and voriconazole‐‘resistant’, whilst none was ‘resistant’ to echinocandins or amphotericin B .…”

“…However, in some published outbreak responses, specimens of urine, stool, drain fluids and other non‐sterile sites, including the nares, vagina, rectum, wounds, vascular line/exit sites and other sites have yielded C . auris . In one study, adding nasal swabs to composite axilla/groin swabs yielded 10.4% (36/346) positive cultures.…”

“…In one study, adding nasal swabs to composite axilla/groin swabs yielded 10.4% (36/346) positive cultures. Of these, 14 (38.9%) were positive on composite axilla/groin swabs plus nasal cultures, 13 (36.1%) were positive on axilla/groin composite swabs alone and only 9 (25%) were positive on nasal cultures alone . Data from colonised patients show that a single negative screen does not reliably exclude carriage, but reliability increases with an increasing number of negative swabs …”

“…Healthcare outbreaks have been reported from at least eight countries . Some outbreaks from Europe and USA are summarised in Table . Where tested, healthcare workers (HCW) were not found to be colonised during outbreaks in the UK and Spain …”