Adoption and Use of a Risk Assessment Tool for Identifying and Controlling the Spread of Candida Auris among Admitted Patients at a Saudi Arabian Hospital

Abstract

Background: The emergence of Candida auris (C. auris), a multidrug-resistant fungal pathogen, poses a significant healthcare challenge, necessitating robust risk-assessment strategies for effective infection control in hospital settings. Objective: This study aimed to assess and quantify the risk of C. auris infection in a tertiary hospital by using an adapted risk assessment tool that considers diverse patient factors and hospital dynamics. Method: The study employed the 'adaptation method,' amalgamating literature review and analysis of individual patient data (IPD), to identify and quantify C. auris infection risk. Using the MRSA risk assessment tool, risk factor information was derived from the literature and adapted based on the IPD, ensuring context-specific relevance. The study was conducted in a 1000-bed tertiary university teaching hospital in Riyadh, triggered by the first C. auris case in 2019, covering the period from January 2020 to December 2022. The variables included admission history, comorbidities, multidrug-resistant organism (MDRO) history, wounds/devices, surgeries, and antimicrobial use. The inclusion criteria targeted high-risk individuals and the exclusion criteria were inpatients. The screening tool was deployed through a PowerForm in selected nursing units with rigorous training for nurses and comprehensive data collection, monitoring, and outcome analysis. Robust statistical methods, including multivariable logistic regression and subgroup analyses, were employed to address potential biases and ensure the internal validity of the study. Results:Graphic and clinical findings were analyzed in a cohort of 68,031 patients. Notably, 9% of the patients had identified risk factors such as septicemia, CKD, DM, or chronic lung disease. Additionally, 7% reported a history of admission to non-KSA hospitals and 14% had contact with MDROs or ASCs. The overall prevalence of positive responses across the assessed risk factors was 6%, underscoring the relevance of these factors to Candida auris infection. Conclusion: The overall prevalence of positive responses across the assessed risk factors was 6%, emphasizing the relevance of these factors in the context of Candida auris infections. These findings provide valuable insights for the development of targeted surveillance and preventive measures in healthcare settings.