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Rapid Assessment and Containment of Candida auris Transmission in Postacute Care Settings-Orange County, California,
Ellora N Karmarkar1, Kathleen O'Donnell2, Christopher Prestel3
1Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, and the California Department of Public Health, Richmond, California (E.N.K.).
Background:
Candida auris, a multidrug-resistant yeast, can spread rapidly in ventilator-capable skilled-nursing facilities (vSNFs) and long-term acute care hospitals (LTACHs). In 2018, a laboratory serving LTACHs in southern California began identifying species of Candida that were detected in urine specimens to enhance surveillance of C auris, and C auris was identified in February 2019 in a patient in an Orange County (OC), California, LTACH. Further investigation identified C auris at 3 associated facilities.
Objective:
To assess the prevalence of C auris and infection prevention and control (IPC) practices in LTACHs and vSNFs in OC.
Design:
Point prevalence surveys (PPSs), postdischarge testing for C auris detection, and assessments of IPC were done from March to October 2019.
Setting:
All LTACHs (n = 3) and vSNFs (n = 14) serving adult patients in OC.
Participants:
Current or recent patients in LTACHs and vSNFs in OC.
Intervention:
In facilities where C auris was detected, PPSs were repeated every 2 weeks. Ongoing IPC support was provided.
Measurements:
Antifungal susceptibility testing and whole-genome sequencing to assess isolate relatedness.
Results:
Initial PPSs at 17 facilities identified 44 additional patients with C auris in 3 (100%) LTACHs and 6 (43%) vSNFs, with the first bloodstream infection reported in May 2019. By October 2019, a total of 182 patients with C auris were identified by serial PPSs and discharge testing. Of 81 isolates that were sequenced, all were clade III and highly related. Assessments of IPC identified gaps in hand hygiene, transmission-based precautions, and environmental cleaning. The outbreak was contained to 2 facilities by October 2019.
Limitation:
Acute care hospitals were not assessed, and IPC improvements over time could not be rigorously evaluated.
Conclusion:
Enhanced laboratory surveillance and prompt investigation with IPC support enabled swift identification and containment of C auris.
Primary Funding Source:
Centers for Disease Control and Prevention.
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