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Early Introductions of Candida auris Detected by Wastewater Surveillance, Utah, USA, 2022-2023
Abstract:
Candida auris is considered a nosocomial pathogen of high concern and is currently spreading across the United States. Infection control measures for C. auris focus mainly on healthcare facilities, yet transmission levels may already be significant in the community before outbreaks are detected in healthcare settings. Wastewater-based epidemiology (culture, quantitative PCR, and whole-genome sequencing) can potentially gauge pathogen transmission in the general population and lead to early detection of C. auris before it is detected in clinical cases. To learn more about the sensitivity and limitations of wastewater-based surveillance, we used wastewater-based methods to detect C. auris in a southern Utah jurisdiction with no known clinical cases before and after the documented transfer of colonized patients from bordering Nevada. Our study illustrates the potential of wastewater-based surveillance for being sufficiently sensitive to detect C. auris transmission during the early stages of introduction into a community.
Insights
Wastewater surveillance can detect the spread of Candida auris (a concerning fungal pathogen) in communities early. This method identified C. auris in Utah before clinical cases appeared, showing its potential for early detection.
Area of Science:
- Environmental microbiology
- Public health surveillance
- Infectious disease epidemiology
Background:
- Candida auris is a significant nosocomial pathogen with increasing prevalence in the US.
- Community transmission of C. auris may occur before detection in healthcare settings.
- Current infection control primarily targets healthcare facilities.
Purpose of the Study:
- To evaluate the sensitivity and limitations of wastewater-based epidemiology for detecting Candida auris.
- To assess early C. auris transmission in a community with no prior known clinical cases.
- To understand the potential for wastewater surveillance in early pathogen detection.
Main Methods:
- Utilized wastewater-based epidemiology, including culture, quantitative PCR, and whole-genome sequencing.
- Analyzed wastewater samples from a southern Utah jurisdiction before and after patient transfers from Nevada.
- Focused on detecting C. auris in the absence of known clinical cases.
Main Results:
- Successfully detected Candida auris in wastewater samples.
- Identified C. auris transmission in the community prior to clinical case detection.
- Demonstrated the sensitivity of wastewater surveillance for early pathogen introduction.
Conclusions:
- Wastewater-based surveillance is a sensitive tool for early detection of C. auris.
- This method can identify community transmission before clinical outbreaks are recognized.
- Wastewater epidemiology offers a valuable approach for public health surveillance of emerging pathogens.
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