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Community-Scale Wastewater Surveillance of Candida auris during an Ongoing Outbreak in Southern Nevada
Casey Barber1,2, Katherine Crank2, Katerina Papp2
1School of Public Health, University of Nevada Las Vegas, 4700 S. Maryland Parkway, Las Vegas, Nevada 89119, United States.
Abstract:
Candida auris is an opportunistic fungal pathogen and an emerging global public health threat, given its high mortality among infected individuals, antifungal resistance, and persistence in healthcare environments. This study explored the applicability of wastewater surveillance for C. auris in a metropolitan area with reported outbreaks across multiple healthcare facilities. Influent or primary effluent samples were collected over 10 weeks from seven sewersheds in Southern Nevada. Pelleted solids were analyzed using an adapted quantitative polymerase chain reaction (qPCR) assay targeting the ITS2 region of the C. auris genome. Positive detection was observed in 72 of 91 samples (79%), with higher detection frequencies in sewersheds serving healthcare facilities involved in the outbreak (94 vs 20% sample positivity). Influent wastewater concentrations ranged from 2.8 to 5.7 log10 gene copies per liter (gc/L), and primary clarification achieved an average log reduction value (LRV) of 1.24 ± 0.34. Presumptive negative surface water and wastewater controls were non-detect. These results demonstrate that wastewater surveillance may assist in tracking the spread of C. auris and serve as an early warning tool for public health action. These findings provide the foundation for future application of wastewater-based epidemiology (WBE) to community- or facility-level surveillance of C. auris and other high consequence, healthcare-associated infectious agents.
Insights
Wastewater surveillance effectively detected Candida auris (C. auris), an emerging fungal threat, in a metropolitan area. This method can track C. auris spread and act as an early warning for public health interventions.
Area of Science:
- Environmental microbiology
- Public health surveillance
- Infectious disease epidemiology
Background:
- Candida auris is a significant global health concern due to its high mortality, antifungal resistance, and persistence in healthcare settings.
- Effective surveillance methods are crucial for managing the spread of this opportunistic fungal pathogen.
Purpose of the Study:
- To evaluate the feasibility of using wastewater surveillance to monitor Candida auris in a metropolitan area experiencing outbreaks.
- To assess the correlation between wastewater detection and healthcare facility outbreaks.
Main Methods:
- Collected wastewater samples from seven sewersheds over 10 weeks.
- Utilized a quantitative polymerase chain reaction (qPCR) assay targeting the ITS2 region for C. auris detection.
- Analyzed influent and primary effluent, calculating log reduction values after primary clarification.
Main Results:
- Detected C. auris in 79% of wastewater samples.
- Observed significantly higher detection rates in sewersheds serving healthcare facilities with C. auris outbreaks (94% vs. 20%).
- Quantified influent concentrations and demonstrated an average log reduction of 1.24 ± 0.34 after primary clarification.
Conclusions:
- Wastewater surveillance is a viable tool for tracking the spread of Candida auris.
- This approach can serve as an early warning system for public health action and guide facility-level surveillance.
- Wastewater-based epidemiology (WBE) shows promise for monitoring high-consequence, healthcare-associated infections.
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