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Candida auris surveillance in the Military Health System: a multidrug-resistant threat
J Joseph Brough1, Graham C Ellis1, Sara L Robinson2
1Walter Reed National Military Medical Center, Bethesda, MD, USA.
Objective:
To evaluate the potential sources and current screening strategies for the multidrug-resistant fungal pathogen Candida auris in the US Military Health System (MHS).
Methods:
Utilizing the Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), 6 instances of C. auris colonization or infection were identified within the MHS in 2024. Relevant medical and social history, drug susceptibilities, and next-generation genetic sequencing were obtained from MRSN and the electronic medical record. Hospital screening protocols for C. auris were reviewed in the affected facilities.
Results:
One case of C. auris infection and 5 cases of C. auris colonization in 2024 were identified in the MHS. Only 1 case of colonization was likely related to international travel; 5 patients had no recent travel history before infection or colonization. One patient was an active duty service member. Prior hospitalizations and infections were the most common risk factors present in each case. Two isolates had antimicrobial susceptibilities analyzed, both of which suggested resistance to fluconazole. Two of the 3 facilities had C. auris screening protocols in place to screen select individuals with risk factors; however, only 1 of the 6 cases presented was identified through these screening protocols. No cases of nosocomial transmission were found.
Conclusions:
C. auris remains a formidable threat to the MHS, with 6 cases identified in 3 treatment facilities, with 2 isolates demonstrating resistance to azoles. Screening protocols should reflect the domestic and international threats of this pathogen.
Insights
Six cases of multidrug-resistant Candida auris were found in the US Military Health System in 2024. Current screening strategies were insufficient to detect most cases, highlighting the need for improved Candida auris surveillance.
Area of Science:
- Infectious Diseases
- Mycology
- Antimicrobial Resistance
Background:
- Candida auris is a multidrug-resistant fungal pathogen posing a significant global health threat.
- The US Military Health System (MHS) needs to understand its vulnerability to C. auris.
- Effective screening and surveillance are crucial for controlling C. auris outbreaks.
Purpose of the Study:
- To evaluate potential sources of Candida auris within the MHS.
- To assess the effectiveness of current screening strategies for C. auris in the MHS.
- To identify gaps in C. auris surveillance and control measures.
Main Methods:
- Utilized the Multidrug-Resistant Organism Repository and Surveillance Network (MRSN) to identify C. auris cases.
- Collected data on medical history, social history, drug susceptibilities, and genetic sequencing.
- Reviewed hospital screening protocols at facilities with identified C. auris cases.
Main Results:
- Identified 6 cases of C. auris (1 infection, 5 colonization) in the MHS in 2024.
- Most cases lacked recent international travel history; prior hospitalizations were common risk factors.
- Two isolates showed resistance to fluconazole; screening protocols identified only one case.
Conclusions:
- Candida auris poses a significant threat to the MHS, with identified azole resistance.
- Current screening protocols are inadequate for detecting C. auris cases effectively.
- Enhanced surveillance and screening strategies are necessary to address domestic and international C. auris threats.
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