Importation, Mitigation, and Genomic Epidemiology of Candida auris at a Large Teaching Hospital

Authors

Emil P. Lesho, Rochester Regional HealthFollow
Melissa Z. Bronstein, Rochester Regional HealthFollow
Patrick McGann, Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland.
Jason Stam, Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland.
Yoon Kwak, Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland.
Rosslyn Maybank, Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland.
Jodi McNamara, Rochester Regional HealthFollow
Megan Callahan, Rochester Regional HealthFollow
Jean Campbell, Rochester Regional HealthFollow
Mary K. Hinkle, Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland.
Edward E. Walsh, University of Rochester School of Medicine, Rochester, New York.

Department

Infectious Diseases

Document Type

Article

Publication Title

Infection control and hospital epidemiology

Abstract

OBJECTIVE Candida auris (CA) is an emerging multidrug-resistant pathogen associated with increased mortality. The environment may play a role, but transmission dynamics remain poorly understood. We sought to limit environmental and patient CA contamination following a sustained unsuspected exposure. DESIGN Quasi-experimental observation. SETTING A 528-bed teaching hospital. PATIENTS The index case patient and 17 collocated ward mates. INTERVENTION Immediately after confirmation of CA in the bloodstream and urine of a patient admitted 6 days previously, active surveillance, enhanced transmission-based precautions, environmental cleaning with peracetic acid-hydrogen peroxide and ultraviolet light, and patient relocation were undertaken. Pre-existing agreements and foundational relationships among internal multidisciplinary teams and external partners were leveraged to bolster detection and mitigation efforts and to provide genomic epidemiology. RESULTS Candida auris was isolated from 3 of 132 surface samples on days 8, 9, and 15 of ward occupancy, and from no patient samples (0 of 48). Environmental and patient isolates were genetically identical (4-8 single-nucleotide polymorphisms [SNPs]) and most closely related to the 2013 India CA-6684 strain (~200 SNPs), supporting the epidemiological hypothesis that the source of environmental contamination was the index case patient, who probably acquired the South Asian strain from another New York hospital. All isolates contained a mutation associated with azole resistance (K163R) found in the India 2105 VPCI strain but not in CA-6684. The index patient remained colonized until death. No surfaces were CA-positive 1 month later. CONCLUSION Compared to previous descriptions, CA dissemination was minimal. Immediate access to rapid CA diagnostics facilitates early containment strategies and outbreak investigations. Infect Control Hosp Epidemiol 2018;39:53-57.

First Page

53

Last Page

57

DOI

10.1017/ice.2017.231

Volume

39

Issue

1

Publication Date

12-7-2017

PubMed ID

29208056

Recommended Citation

Lesho, E. P., Bronstein, M. Z., McGann, P., Stam, J., Kwak, Y., Maybank, R., McNamara, J., Callahan, M., Campbell, J., Hinkle, M. K., & Walsh, E. E. (2017). Importation, Mitigation, and Genomic Epidemiology of Candida auris at a Large Teaching Hospital. Infection control and hospital epidemiology, 39 (1), 53-57. https://doi.org/10.1017/ice.2017.231