BACKGROUNDCandida auris is an emerging and multidrug-resistant pathogen. Here we report the epidemiology of a hospital outbreak of C. auris colonization and infection. METHODSAfter identification of a cluster of C. auris infections in the neurosciences intensive care unit (ICU) of the Oxford University Hospitals, United Kingdom, we instituted an intensive patient and environmental screening program and package of interventions. Multivariable logistic regression was used to identify predictors of C. auris colonization and infection. Isolates from patients and from the environment were analyzed by whole-genome sequencing. RESULTSA total of 70 patients were identified as being colonized or infected with C. auris between February 2, 2015, and August 31, 2017; of these patients, 66 (94%) had been admitted to the neurosciences ICU before diagnosis. Invasive C. auris infections developed in 7 patients. When length of stay in the neurosciences ICU and patient vital signs and laboratory results were controlled for, the predictors of C. auris colonization or infection included the use of reusable skin-surface axillary temperature probes (multivariable odds ratio, 6.80; 95% confidence interval [CI], 2.96 to 15.63; P<0.001) and systemic fluconazole exposure (multivariable odds ratio, 10.34; 95% CI, 1.64 to 65.18; P = 0.01). C. auris was rarely detected in the general environment. However, it was detected in isolates from reusable equipment, including multiple axillary skin-surface temperature probes. Despite a bundle of infection-control interventions, the incidence of new cases was reduced only after removal of the temperature probes. All outbreak sequences formed a single genetic cluster within the C. auris South African clade. The sequenced isolates from reusable equipment were genetically related to isolates from the patients. CONCLUSIONSThe transmission of C. auris in this hospital outbreak was found to be linked to reusable axillary temperature probes, indicating that this emerging pathogen can persist in the environment and be transmitted in health care settings.

We identified low but escalating risk of severe M. chimaera infection associated with heater-coolers with cases in a quarter of cardiothoracic centers. Our investigations strengthen etiological evidence for the role of heater-coolers in transmission and raise the possibility of an ongoing, international point-source outbreak. Active management of heater-coolers and heightened clinical awareness are imperative given the consequences of infection.

Aims:  To investigate factors influencing the recovery of micro‐organisms from surfaces using traditional swabbing techniques. Methods and Results:  Stainless steel squares were inoculated with known levels (approx. 2·7 × 102–2·7 × 104) of either Escherichia coli or Staphylococcus aureus and sampled using different swab/solution combinations. Overlaying the coupons with agar allowed colonies remaining on the surface to be enumerated. Conventional cultivation was used to determine the ease with which the bacteria were released from the swabs and the viability of the organisms within the solutions over a 24‐h period. Minimal bacterial growth occurred when the samples were stored at 4°C. At room temperature, whilst the presence of nutrients significantly increased bacterial numbers over time, the addition of Tween 80 to nutrient depleted environments significantly reduced the viability of Staph. aureus. The percentage of bacteria released from directly inoculated swabs was significantly higher than that recovered from surface swabs, highlighting the importance of effectively removing bacterial contaminants from a surface. Increasing the level of mechanical energy generated during swabbing increased the number of bacteria removed from a wet surface. However, it is hypothesized that cellular damage, perhaps caused by the swabbing action itself, may have reduced recoverability from a dry surface. Nonetheless, an increased ability to effectively remove bacteria from a surface did not necessarily correlate with higher bacterial recovery, implying that an equally important factor in terms of swabbing efficiency is the ability of a swab to effectively release bacteria into a diluent. Conclusions:  Both swab and wetting solution can influence the number of bacteria recovered. Under the experimental conditions described here, the use of swabs coated with a brush‐textured nylon flock in combination with a non‐growth‐enhancing wetting solution appeared the best system to use when sampling a wet surface. However, this combination may not always be ideal and proper consideration must be given to how the sample is to be taken, transported and, if necessary, stored prior to analysis. Significance and Impact of the Study:  Careful selection of swabbing materials can increase the sensitivity of traditional microbiological analysis. However, any improvements made are likely to be insignificant in relation to the overall poor performance of the swabbing technique.

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ISRCTN. Identifier: 06298448. http://www.controlled-trials.com/isrctn/.

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