Axillary Digital Thermometers uplifted a multidrug‐susceptible Candidaauris outbreak among COVID‐19 patients in Brazil

Abstract

Objectives To describe the first outbreak of Candida auris in Brazil, including epidemiological, clinical and microbiological data. Methods After the first Candida auris ‐colonised patient was diagnosed in a COVID‐19 ICU at a hospital in Salvador, Brazil, a multidisciplinary team conducted a local C . auris prevalence investigation. Screening cultures for C . auris were collected from patients, healthcare workers and inanimate surfaces. Risk factors for C . auris colonisation were evaluated, and the fungemia episodes that occurred after the investigation were also analysed and described. Antifungal susceptibility of the C . auris isolates was determined, and they were genotyped with microsatellite analysis. Results Among body swabs collected from 47 patients, eight ( n = 8/47, 17%) samples from the axillae were positive for C . auris . Among samples collected from inanimate surfaces, digital thermometers had the highest rate of positive cultures ( n = 8/47, 17%). Antifungal susceptibility testing showed MICs of 0.5 to 1 mg/L for AMB, 0.03 to 0.06 mg/L for voriconazole, 2 to 4 mg/L for fluconazole and 0.03 to 0.06 mg/L for anidulafungin. Microsatellite analysis revealed that all C . auris isolates belong to the South Asian clade (Clade I) and had different genotypes. In multivariate analysis, having a colonised digital thermometer was the only independent risk factor associated with C . auris colonisation. Three episodes of C . auris fungemia occurred after the investigation, with 30‐day attributable mortality of 33.3%. Conclusions Emergence of C . auris in Salvador, Brazil, may be related to local C . auris clade I closely related genotypes. Contaminated axillary monitoring thermometers may facilitate the dissemination of C . auris reinforcing the concept that these reusable devices should be carefully cleaned with an effective disinfectant or replaced by other temperature monitoring methods.

Impact of SARS-CoV-2 Epidemic on Antimicrobial Resistance: A Literature Review

“…Another aspect that deserves special consideration is the importance of environmental contamination. In the setting of a COVID-19 ICU, fomite transmission, which is challenging both to recognize and to eradicate [97], was identified to be responsible for nosocomial transmission of KPC-Kp in Germany (ventilators), and in Brazil C. auris (axillary thermometers) [85]-and it is a well-known source of nosocomial outbreaks of MRSA [15] and CRAB [12]. In New Jersey, during a peak of COVID-19 cases in April 2020, Perez et al reported several unintentional changes in standard infection prevention and control (IPC) practices, which included a temporary discontinuation of appropriate PPE use, environmental cleaning and prolonged use of ventilator circuits and suctioning catheters [98].…”

“…During the ongoing COVID-19 pandemic, the large number of COVID-19 patients requiring critical care and the prolonged use of personal protective equipment (PPE) by the healthcare personnel may have inadvertently mediated a silent dissemination of this fungal pathogen [83,84]. For instance, in an epidemiological investigation conducted in Brazil, Nobrega de Almeida et al found that axillary monitoring thermometers may facilitate the dissemination of C. auris in hospital settings [85].…”

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

“…Nine case reports and seven case series were retrieved [108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123], together reporting 41 cases of candidemia (Table 4; detailed information about the individual studies is given in Table S4). The median time from ICU admission or intubation to the diagnosis of candidemia was 13.5 days (IQR 7.5-29.5), and more than 80% of the patients had an indwelling vascular catheter, received broad-spectrum antibiotics, and underwent mechanical ventilation before its onset.…”

Overview on the Prevalence of Fungal Infections, Immune Response, and Microbiome Role in COVID-19 Patients

“…Critically, C. auris could be easily spread because of the COVID-19 pandemic [ 35 ]. After the first C. auris -colonized case was diagnosed in a COVID-19 patient in ICU at a hospital in Salvador, Brazil, a multidisciplinary team conducted a local C. auris prevalence investigation [ 36 ]. Remarkably, findings revealed that among body swabs collected from 47 patients, eight samples from the axillae were positive for C. auris .…”

“…Contaminated axillary monitoring thermometer helped to C. auris dissemination. Re-use of these devices must imply a careful disinfection or they should be replaced by other temperature monitoring methods [ 36 ]. Moreover, in 2020, the Florida Department of Health was alerted to three C. auris bloodstream infections and one urinary tract infection (UTI) in four patients with COVID-19 who had received care in the same COVID-19 ICU ward [ 37 ].…”