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Candida auris outbreak: Mortality, interventions and cost of sustaining control
Surabhi K Taori1, Kirstin Khonyongwa1, Iain Hayden1
1Department of Medical Microbiology, King's College Hospital NHS Foundation Trust Denmark Hill, London SE5 9RS, UK.
Objective:
Candida auris has recently emerged as a global cause of multidrug resistant fungal outbreaks. An outbreak occurred at a tertiary care center in London in 2016. Transmission characteristics, interventions, patient outcomes and cost of resources are described.
Methods:
Outbreak interventions included patient isolation, contact screening, single-use equipment, environmental screening and decontamination, staff education, and enhanced surveillance. Risk factors for infection were recorded. Survival probabilities of patients with C. auris and other Candida bloodstream infections (BSI) were calculated. Antifungal susceptibility and epidemiological typing were performed. Actual and opportunity costs of interventions were determined.
Results:
34 patients acquired the organism including 8 with BSI. Clinical infection was significantly associated with prolonged hospital stay, haemodialysis and antifungal therapy. Variable susceptibility to amphotericin and the triazoles was seen and isolates clustered with the South Asian strains. No significant difference was detected in the survival probabilities of C. auris BSI compared to other candidemias. Outbreak control cost in excess of £1 million and £58,000/month during the subsequent year.
Conclusion:
C. auris outbreaks can be controlled by a concerted infection control strategy but can be expensive. Transmission maybe prolonged due to patient movements and unidentified transmission mechanisms.
Insights
Multidrug-resistant Candida auris outbreaks require comprehensive infection control strategies for containment. While effective, these measures, including isolation and decontamination, incur significant costs, highlighting the economic impact of controlling this emerging fungal threat.
Area of Science:
- Infectious Diseases
- Mycology
- Public Health
Background:
- Candida auris is an emerging global threat causing multidrug-resistant fungal outbreaks.
- A significant outbreak occurred at a London tertiary care center in 2016, necessitating detailed analysis.
Purpose of the Study:
- To describe transmission characteristics, interventions, patient outcomes, and resource costs associated with a Candida auris outbreak.
- To evaluate the effectiveness and economic impact of infection control measures against multidrug-resistant Candida auris.
Main Methods:
- Implemented interventions included patient isolation, contact screening, single-use equipment, environmental decontamination, staff education, and enhanced surveillance.
- Risk factors, survival probabilities (compared to other Candida bloodstream infections), antifungal susceptibility, and epidemiological typing were assessed.
- Actual and opportunity costs of outbreak control interventions were determined.
Main Results:
- 34 patients acquired Candida auris, with 8 developing bloodstream infections (BSI).
- Prolonged hospital stay, haemodialysis, and prior antifungal therapy were risk factors for infection.
- No significant difference in survival probabilities was found between C. auris BSI and other candidemias; outbreak control exceeded £1 million.
Conclusions:
- Concerted infection control strategies can control C. auris outbreaks but are costly.
- Prolonged transmission may be influenced by patient movement and unidentified mechanisms, necessitating ongoing surveillance and research.
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