Study Reveals Transmission of Candida auris from Adults to Children in Maryland Hospital

Candida auris fungi, emerging multidrug-resistant fungus

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Whole Genome Sequencing (WGS) showed that isolates from 2 adults and 1 pediatric patient differed by fewer than 3 single nucleotide polymorphisms (SNP), indicating a common isolate. Another pediatric case emerged from surveillance cultures taken from 27 patients. The investigation into potential transmission pathways identified healthcare personnel who worked in both units, specifically clinical teams, and continuous electroencephalography (cEEG) technologists.

Despite extensive environmental testing that returned negative for C auris on cEEG and other equipment, the risk of fomite transmission was not ruled out. The investigation spanned from June to September 2023, identifying possible transmission pathways of C auris between an adult Neuroscience Intensive Care Unit (ICU) and a pediatric ICU. Transmission was potentially facilitated by shared healthcare personnel, including clinical teams and continuous electroencephalography (cEEG) technologists, who worked across both units.

Following the detection of C auris, an extensive infection control investigation was initiated. This included interviews with staff, direct observations, and a review of medical charts. A case was defined by detecting C auris from clinical or surveillance cultures. Surveillance involved collecting nares and composite axilla/groin swabs from patients in the affected units, and environmental surfaces were swabbed using moistened E-Swabs and cultured on CHROMagar Candida plates. Isolates obtained from patients admitted between February 2022 and October 2023 were analyzed using Illumina NextSeq 300 bp paired-end sequencing with SNP analysis compared raw reads against the reference C auris B8441 genome for clustering analysis.

To maintain preventative measures for hospital-associated C auris transmission, strict adherence to hand hygiene, contact precautions, and comprehensive cleaning and disinfection of patient environments and equipment. Additional measures involved educating multi-disciplinary personnel on infection prevention, monitoring adherence to infection prevention protocols, and intensifying environmental cleaning to control the risk of transmission.

Reference

Erin Banker, BSPH. Hospital-Associated Transmission of Candida auris from Adult to Pediatric Patient (079) Poster #79 presented at SHEA 2024 April 16-19, 2024. Houston, TX.