These 5 Factors Are Associated with Candida auris Colonization in Nursing Homes

Even before Candida auris made the front page of The New York Times earlier this month, the emerging health care-associated fungal infection has been worrying providers all over the world due to its multidrug-resistance and invasiveness.

New York state has the highest rate of colonization, with more than 500 colonized and infected individuals, most of whom reside in nursing homes and many of whom are mechanically ventilated.

Investigators with the US Centers for Disease Control and Prevention (CDC) and the New York State Department of Health (NYSDOH) analyzed the factors that lead to Candida colonization in order to identify opportunities to reduce transmission. Their findings were presented at the Society for Healthcare Epidemiology of America Spring Conference (SHEA 2019).

From 2016 to 2018, the research team conducted point prevalence surveys for C auris colonization among nursing home residents in New York state. Swabs were collected from residents’ axilla, groin, and nares, and data on facility transfers, antimicrobials, and medical history were extracted from medical records.

The team deployed a matched case-control investigation, where a case was defined as C auris colonization in a resident and then matched with up to 4 residents with negative swabs during the same point prevalence survey.

In total, investigators used 12 point prevalence surveys at 6 nursing homes to identify 60 cases and 218 controls. The team controlled for age, underlying conditions, functional status, and infection with other multidrug-resistant organisms in the 90 days before screening. Investigators determined that the following factors are associated with C auris colonization: having a urinary catheter (adjusted odds ratio [aOR]: 2.5; 95% [Confidence Interval] CI: 1.1—5.4), having a tracheostomy (aOR: 8.2; 95% CI: 1.1–58.8), being on a ventilator (aOR: 3.4; CI: 1.2–9.2), receiving meropenem in the prior 90 days (aOR: 2.5; CI: 1.2–5.3), and having ≥1 hospitalization in the prior 6 months (aOR: 4.3; CI: 1.8–10.0).

“Targeted screening of patients with the above risk factors for C auris can help identify those who are colonized and facilitate implementation of infection control measures to prevent transmission,” investigators concluded. “Antibiotic stewardship and interfacility communication may be important factors in the prevention of C auris colonization.”

The study, “Factors associated with Candida auris colonization among residents of nursing homes with ventilator units — New York, 2016 — 2018,” was presented in an oral session on April 24, 2019, at SHEA in Boston, Massachusetts.