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Candida auris Outbreak and Epidemiologic Response in Burn Intensive Care Unit, Illinois, USA, 2021-2023
Abstract:
Candida auris is an emerging fungal pathogen associated with outbreaks in healthcare settings. We report a multiyear outbreak of C. auris in a burn intensive care unit in Illinois, USA, during 2021-2023. We identified 28 C. auris cases in the unit over a 2-year period, despite outbreak response and multimodal mitigation measures. Of the 28 case-patients, 15 (53.6%) were considered colonized and 13 (46.4%) had clinical infections. Phylogenetic analysis of whole-genome sequences revealed 4 distinct clusters of closely related (0-6 SNP differences) genomes containing 3-6 cases. Clusters generally contained temporally related isolates from patients with epidemiologic links; this finding suggests that multiple introductions and within-unit spread over a limited time were responsible for the outbreak, rather than transmission from a long-term source (e.g., persistent environmental contamination or staff carriage). Here, integrated traditional and genomic epidemiology supported C. auris outbreak investigation and response and informed targeted interventions.
Insights
A multiyear Candida auris outbreak in a burn ICU involved 28 cases. Genomic analysis revealed multiple introductions and spread within the unit, not long-term contamination, guiding interventions.
Area of Science:
- Infectious Diseases
- Epidemiology
- Genomics
Background:
- Candida auris is a significant emerging fungal pathogen causing healthcare-associated outbreaks.
- Burn intensive care units are particularly vulnerable to multidrug-resistant organism colonization and infection.
Purpose of the Study:
- To investigate a multiyear Candida auris outbreak in a US burn intensive care unit.
- To characterize the transmission dynamics and genetic relatedness of Candida auris isolates during the outbreak.
Main Methods:
- Retrospective analysis of clinical and epidemiological data from 2021-2023.
- Whole-genome sequencing and phylogenetic analysis of Candida auris isolates.
- Integration of traditional epidemiology with genomic data for outbreak investigation.
Main Results:
- Identified 28 cases of Candida auris (15 colonized, 13 infected) over two years.
- Phylogenetic analysis revealed 4 distinct clusters of closely related isolates.
- Findings suggest multiple introductions and within-unit transmission rather than a single persistent source.
Conclusions:
- Integrated genomic and traditional epidemiology effectively supported outbreak investigation and response.
- Targeted interventions informed by molecular data can help manage Candida auris outbreaks.
- Understanding transmission patterns is crucial for controlling Candida auris in high-risk settings.
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