Increased Incidence of Candida auris Colonization in Early COVID-19 Pandemic, Orange County, California, USA

Candida auris transmission surged in long-term acute-care hospitals (LTACHs) in Orange County, California, USA, during the COVID-19 pandemic. This study describes the effect of COVID-19 on C. auris transmission by estimating the probability of patient colonization in LTACHs across 5 epidemiologic time periods. Patients had the highest probability of developing new skin colonization during the first COVID-19 wave, with a cumulative incidence of 22.5% (95% CI 18.5--26.6) after a 30-day stay. Once the initial COVID-19 waves abated, a reduction in cumulative incidence of C. auris colonization was observed concurrently with persistent high prevalence, indicating that within-facility transmission can be reduced with proper infection prevention and control practices. Admission screenings and point prevalence surveys provided a wealth of data that guided public health recommendations and supported the objectives of both public health professionals and LTACHs for monitoring facility transmission dynamics and guiding decision making.