Getting Ahead of Candida auris: Tales from IDWeek 2019

As IDWeek 2019 continued into the weekend, there was no shortage of information for those seeking to prevent and control infectious diseases. For many of us, the threat of antimicrobial resistance has been a major challenge and one for which guidance is desperately needed.

Challenging organisms, like Candida auris, make infection prevention efforts in health care that much more difficult and patient care intrinsically more dangerous.

In a presentation at the meeting, the presenting author and medical epidemiologist, Snigdha Vallabhaneni, represented the US Centers for Disease Control and Prevention (CDC), while co-authors included experts from health care and public health from California, Connecticut, and CDC.

Researchers emphasized that over 1600 patients have been identified in the United States to have C auris infections or colonization. Of those confirmed cases, risk factors were identified, which include high-acuity post-acute care admissions — like long-term acute care hospitalizations, colonization with carbapenemase-producing organisms (CPOs), or hospitalization abroad.

Ultimately, the spread of C auris is deeply worrisome as it represents what the CDC reports “an emerging fungus that presents as serious global health threat”. C auris induces concern for its frequent capacity to become multidrug-resistant, the challenges of identifying infections with standard lab methods, and because it has caused outbreaks in health care settings. To help strengthen surveillance of this organism, the abstract focused on 4 active surveillance strategies that can lead to early C auris detection.

Utilizing the knowledge of aforementioned risk factors, state health departments designed these 4 strategies: 1) species identification of yeast from urine cultures from long-term acute care hospitals (LTACHs) 2) screening patients with a CPO and hospitalization abroad 3) LTACH C auris point prevalence surveys (PPS); 4) admission screening in acute and long-term care settings.

Surveillance efforts focused on a Southern California lab that served 12 long-term acute care hospitals. Species identification for all Candida urine isolates was conducted. The authors note that “within 5 months, testing of 271 Candida urine isolates identified the region’s first C auris case, prompting contact tracing and identification of additional cases and facilities. When CPOs were identified in patients with recent hospitalizations outside of the US, the Maryland Department of Health screened patients for C auris colonization. Of 4 screened, 1 who received care in Kenya, was C auris colonized. The Indiana State Department of Health implemented monthly PPS at an LTACH that frequently admits patients transferred from a high prevalence area. Of 38 patients screened, 2 were colonized.”

Moreover, for the Connecticut Department of Public Health, the established practice of offering C auris admission screening for those patients who were recently inpatient (i.e. hospitalized) in areas deemed high prevalence. This practice identified C auris in 1 of the 12 individuals who were screened.

In each case, the identification of a previously unknown C auris patient allowed for infection prevention and control measures, including isolation. Ultimately, what the researchers emphasized what that given the threat C auris poses, surveillance strategies are critical to help guide infection prevention efforts. Joint efforts between health care facilities and public health are necessary to combat the growing challenge of antimicrobial resistance and C auris.

The abstract, Early Detection of Candida auris is Essential to Control Spread: Four Effective Active Surveillance Strategies, was presented on Saturday, October 5^th, 2019, IDWeek 2019 in Washington, DC.