Regional Emergence ofCandida aurisin Chicago and Lessons Learned From Intensive Follow-up at 1 Ventilator-Capable Skilled Nursing Facility

Abstract

Background Since the identification of the first 2 Candida auris cases in Chicago, Illinois, in 2016, ongoing spread has been documented in the Chicago area. We describe C. auris emergence in high-acuity, long-term healthcare facilities and present a case study of public health response to C. auris and carbapenemase-producing organisms (CPOs) at one ventilator-capable skilled nursing facility (vSNF-A). Methods We performed point prevalence surveys (PPSs) to identify patients colonized with C. auris and infection-control (IC) assessments and provided ongoing support for IC improvements in Illinois acute- and long-term care facilities during August 2016–December 2018. During 2018, we initiated a focused effort at vSNF-A and conducted 7 C. auris PPSs; during 4 PPSs, we also performed CPO screening and environmental sampling. Results During August 2016–December 2018 in Illinois, 490 individuals were found to be colonized or infected with C. auris. PPSs identified the highest prevalence of C. auris colonization in vSNF settings (prevalence, 23–71%). IC assessments in multiple vSNFs identified common challenges in core IC practices. Repeat PPSs at vSNF-A in 2018 identified increasing C. auris prevalence from 43% to 71%. Most residents screened during multiple PPSs remained persistently colonized with C. auris. Among 191 environmental samples collected, 39% were positive for C. auris, including samples from bedrails, windowsills, and shared patient-care items. Conclusions High burden in vSNFs along with persistent colonization of residents and environmental contamination point to the need for prioritizing IC interventions to control the spread of C. auris and CPOs.

Colonisation and Transmission Dynamics of Candida auris among Chronic Respiratory Diseases Patients Hospitalised in a Chest Hospital, Delhi, India: A Comparative Analysis of Whole Genome Sequencing and Microsatellite Typing

“…Previously, a contact tracing and epidemiologic investigation surrounding cases earlier in the C. auris epidemic in New York revealed that colonisation rates varied by facility type, i.e., hospitals (5%), long term care facilities (LTCF, 6.3%), long term acute care (2.9%), and co-located hospital and LTCF (12.3%) [ 38 ]. C. auris colonisation rates in skilled nursing facilities that cared for ventilated patients were nearly ten times higher than the prevalence in skilled nursing facilities that did not provide care for ventilated residents [ 38 , 39 ]. It is pertinent to emphasize that colonisation by C. auris predisposes patients at risk for invasive infection as 5–10% of known colonised patients have been reported to develop invasive infections [ 10 ].…”

On the emergence, spread and resistance of Candida auris: host, pathogen and environmental tipping points

“…During this period cases reached Australia (2015) as well [49]. Around the same time when cases emerged in the UK, C. auris had entered the USA (2013) as well [50], and it triggered prolonged large outbreaks in New York, New Jersey and Chicago over 2013–17 [8, 51]. Soon after, in 2017, C. auris cases emerged in Canada [52].…”

Regional spread of blaNDM-1-containing Klebsiella pneumoniae Sequence Type 147 in post-acute care facilities

“…Second, patients in vSNFs generally have long lengths of stay — often much longer than patient stays at LTACHs [66] — meaning that they have a longer period of time to acquire a multi-drug resistant organism. Furthermore, multibed rooms are common and the facilities themselves are often under-resourced from a staffing and infection control perspective [6], both of which could facilitate intra-facility spread. Our findings paired with these observations indicate that vSNFs may be important healthcare facilities to detect emerging threats and potentially contain them before widespread dissemination.…”

“…Long-term acute care hospitals (LTACHs) and ventilator-capable skilled nursing facilities (vSNFs) are potentially high-impact settings for implementation of regional CRE surveillance and infection prevention interventions [5,6]. Patients in these facilities have been shown to be colonized with CRE at high rates, likely due to a combination of their chronic severe illness, long lengths of stay, and high rates of prior or on-going antibiotic exposure.…”