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Candida auris Colonization After Discharge to a Community Setting: New York City, 2017-2019
Genevieve Bergeron1,2, Danielle Bloch1, Kenya Murray1
1New York City Department of Health and Mental Hygiene, Queens, New York, USA.
Background:
Patients colonized with multidrug-resistant Candida auris and discharged to a community setting can subsequently seek care in a different healthcare facility and might be a source of nosocomial transmission of C auris.
Methods:
We designed a case management pilot program for a cohort of New York City residents who had a history of positive C auris culture identified during clinical or screening activities in healthcare settings and discharged to a community setting during 2017-2019. Approximately every 3 months, case managers coordinated C auris colonization assessments, which included swabs of groin, axilla, and body sites yielding C auris previously. Patients eligible to become serially negative were those with ≥2 C auris colonization assessments after initial C auris identification. Clinical characteristics of serially negative and positive patients were compared.
Results:
The cohort included 75 patients. Overall, 45 patients were eligible to become serially negative and had 552 person-months of follow-up. Of these 45 patients, 28 patients were serially negative (62%; rate 5.1/100 person-months), 8 were serially positive, and 9 could not be classified as either. There were no clinical characteristics that were significantly different between serially negative and positive patients. The median time from initial C auris identification to being serially negative at assessments was 8.6 months (interquartile range, 5.7-10.8 months).
Conclusions:
A majority of patients, assessed at least twice after C auris identification, no longer had C auris detectable on serial colonization assessments.
Insights
A pilot program found that most patients with multidrug-resistant Candida auris (C. auris) became colonization-negative within months. This suggests effective case management can reduce C. auris transmission risk in the community.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Multidrug-resistant Candida auris (C. auris) poses a significant risk for nosocomial transmission.
- Patients discharged with C. auris colonization can spread the fungus in community settings and to other healthcare facilities.
Purpose of the Study:
- To evaluate the effectiveness of a case management pilot program for C. auris colonization in New York City residents.
- To determine the rate and characteristics of patients who become serially negative for C. auris colonization after discharge.
Main Methods:
- A pilot program followed a cohort of NYC residents with a history of C. auris positive cultures discharged to the community (2017-2019).
- Case managers coordinated C. auris colonization assessments (groin, axilla, previous positive sites) every ~3 months.
- Patients with ≥2 negative assessments after initial identification were considered serially negative; clinical characteristics were compared.
Main Results:
- The cohort included 75 patients; 45 were eligible for serial assessment (552 person-months follow-up).
- 62% (28/45) of eligible patients became serially negative for C. auris.
- Median time to becoming serially negative was 8.6 months; no significant clinical differences were found between serially negative and positive patients.
Conclusions:
- A majority of patients assessed at least twice after C. auris identification cleared the colonization.
- The findings suggest that case management can lead to successful C. auris clearance in a community setting.
- This highlights the potential for reducing C. auris transmission through targeted patient management.
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