Trends of Colonization and Clinical Cases of Candida Auris in the Chicago Area

In a presentation at ID Week 2018 in San Francisco, California, Sarah Kemble, MD, medical director of communicable diseases at the Chicago Department of Public Health, presented an Oral Abstract Session about the emergence of Candida auris, an emerging fungal disease presenting a serious health threat in the Chicago region of Illinois.

In an exclusive interview, Dr. Kemble sat down with Contagion® to speak about the presentation and how the Chicago area has experienced increased prevalence of C auris cases, with 24 clinical cases, including 10 bloodstream infections, reported from May 2016 to January 2018 (see video).

“Candida auris is increasing in certain settings and certain parts of the country,” Dr. Kemble said. “Right now, the areas of the country that are seeing the most Candida auris are the Chicago metropolitan area and parts of New York and New Jersey.”

In response to the first two cases of C auris in the area, state and local health officials launched an investigation into clinical cases and performed point prevalence surveys to identify colonized cases.

According to the abstract, clinical cases had positive C auris cultures obtained for clinical care and colonized cases had positive surveillance cultures during point prevalence surveys.

From August 2016 through January 2018, health workers performed 33-point prevalence surveys across the Chicago area at 20 facilities. Facilities with epidemiological links to cases were prioritized. The surveys were conducted at 5 acute care hospitals, 5 long-term acute care hospitals, 3 high acuity floors of skilled nursing facilities and 7 skilled nursing facilities caring for ventilated patients. Assenting patients were evaluated for colonization through axilla/groin swabs.

A total of 1,364 patients were screened and 92 (6.7%) were found to be colonized with C auris. Ten of the 20 facilities had >1 colonized patients.

Trends in the screening process included a higher proportion of positive screenings between September 2017 and January 2018, with 84 cases in 822 screenings, or 10% when compared to August 2016 to August 2017, with 8 cases in 542 screenings, or 1.5% (z-test P<0.01).

Dr. Kemble and the investigators determined that colonization was highest in the skilled nursing facilities caring for ventilated patients (median: 7.7%; range: 0%—43.3%), compared to acute care hospitals (0%; 0%–6.3%), long-term acute care hospitals (0%; 0%–14.3%), and skilled nursing facilities (0%, 0%–1.5%). Overall the point prevalence surveys in the skilled nursing facilities caring for ventilated patients identified 84 of the 93 (91%) colonized cases.

Additionally, among the 5 skilled nursing facilities caring for ventilated patients with repeat point prevalence surveys, 4 had higher prevalence on repeat screening (median: 26.1%; range: 0%—43.3%) than at baseline (1.2%; 0%–17.0%).

When speaking with Contagion^®, Dr. Kemble provided an update on the current burden of C auris in the Chicago region, which has grown since the submission of the abstract.

“The burden in the Chicago area has grown,” Dr. Kemble explained. “In my abstract I talked about a median prevalence in certain types of facilities of about 8%, but since the abstract was submitted, we are now seeing prevalence range in these same long-term care settings anywhere from 20% to 70%.”

The abstract concludes that C auris is rapidly emerging in the Chicago area, and that increasing the prevalence of colonization during repeat point prevalence surveys indicates transmission and amplification in skilled nursing facilities caring for ventilated patients.

State and local health departments provided recommendations for controlling infections. They also issued health alerts and recommended the placement of patients from high-acuity floors in skilled nursing facilities caring for ventilated patients on “transmission-based precautions to prevent further spread.

Dr. Kemble spoke with Contagion® about what health care providers in areas where C auris prevalence is increasing should know about the fungus. (see video).

“There’s a need to understand some of the testing issues around C auris, so it’s not easily detectable by standard testing methodologies,” Dr. Kemble stressed. “…There are some lookalike bugs, C haemulonii, and others that if you’re seeing a patient with that organism, you may want to make sure your laboratory is doing appropriate testing to verify it is not C auris.”

Additionally, Dr. Kemble recommends the use of sporicidal cleansers that can diminish the threat of the spread of C auris and for providers to be cognizant of the settings that patients are being admitted from to determine whether or not contact isolation is required.

Disclosures: None