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Published on: December 28, 2017
Integrated genomic, epidemiologic investigation of Candida auris skin colonization in a skilled nursing facility
Diana M Proctor1, Thelma Dangana2, D Joseph Sexton3
1Microbial Genomics Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
Abstract:
Candida auris is a fungal pathogen of high concern due to its ability to cause healthcare-associated infections and outbreaks, its resistance to antimicrobials and disinfectants and its persistence on human skin and in the inanimate environment. To inform surveillance and future mitigation strategies, we defined the extent of skin colonization and explored the microbiome associated with C. auris colonization. We collected swab specimens and clinical data at three times points between January and April 2019 from 57 residents (up to ten body sites each) of a ventilator-capable skilled nursing facility with endemic C. auris and routine chlorhexidine gluconate (CHG) bathing. Integrating microbial-genomic and epidemiologic data revealed occult C. auris colonization of multiple body sites not targeted commonly for screening. High concentrations of CHG were associated with suppression of C. auris growth but not with deleterious perturbation of commensal microbes. Modeling human mycobiome dynamics provided insight into underlying alterations to the skin fungal community as a possible modifiable risk factor for acquisition and persistence of C. auris. Failure to detect the extensive, disparate niches of C. auris colonization may reduce the effectiveness of infection-prevention measures that target colonized residents, highlighting the importance of universal strategies to reduce C. auris transmission.
Insights
Candida auris extensively colonizes skin, often undetected on multiple body sites. Chlorhexidine gluconate bathing suppressed Candida auris without harming beneficial skin microbes, suggesting universal bathing strategies may reduce transmission.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Microbiome Research
Background:
- Candida auris is a significant healthcare-associated pathogen known for antimicrobial resistance and persistence.
- Understanding C. auris colonization extent and associated skin microbiome is crucial for effective control.
- Skilled nursing facilities with endemic C. auris present a unique setting for studying colonization and mitigation.
Purpose of the Study:
- To determine the full extent of Candida auris skin colonization in residents.
- To investigate the relationship between the skin microbiome and C. auris colonization.
- To evaluate the impact of chlorhexidine gluconate (CHG) bathing on C. auris and the skin microbiome.
Main Methods:
- Collected swab specimens from up to ten body sites per resident across three time points.
- Integrated microbial-genomic and epidemiologic data for comprehensive analysis.
- Modeled human mycobiome dynamics to understand fungal community alterations.
Main Results:
- Identified occult C. auris colonization across multiple body sites not typically screened.
- Found high concentrations of CHG suppressed C. auris growth effectively.
- Observed no significant detrimental impact of CHG on commensal skin microbes.
- Mycobiome modeling suggested alterations in the fungal community as a risk factor for C. auris.
Conclusions:
- Extensive and disparate colonization niches for C. auris exist, often missed by standard screening.
- CHG bathing shows promise in suppressing C. auris without disrupting the commensal microbiome.
- Targeting the skin fungal community may offer a modifiable risk factor for C. auris acquisition and persistence.
- Universal strategies are important to reduce C. auris transmission due to widespread colonization.
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