Evaluating the measures taken to contain a Candida auris outbreak in a tertiary care hospital in South India: an outbreak investigational study

Abstract

Background Candida auris infections are an emerging global threat with poor clinical outcome, high mortality rate, high transmission rate and outbreak potential. The objective of this work is to describe a multidisciplinary approach towards the investigation and containment of a Candida auris outbreak and the preventive measures adopted in a resource limited setting. Methods This outbreak investigational study was conducted at a 1300-bedded tertiary care academic hospital in South India. The study included 15 adult inpatients with laboratory confirmed Candida auris isolates. The outbreak cluster was identified in adult patients admitted from September 2017 to 2019. The system response consisted of a critical alert system for laboratory confirmed Candida auris infection and multidisciplinary ‘Candida auris care team’ for patient management. The team implemented stringent Infection Prevention and Control (IPC) measures including patient cohorting, standardized therapy and decolonization, staff training, prospective surveillance and introduction of Candida auris specific care bundle. Results Two outbreak clusters were identified; first cluster occurring between October and November 2017 and the second cluster in May 2018. The cohorts consisted of 7 and 8 Candida auris positive patients in the first and second waves of the outbreak respectively with a total survival rate of 93% (14/15). Deployment of containment measures led to gradual decline in the incidence of adult Candida auris positive cases and prevented further cluster formation. Conclusions The sustained implementation of guideline and evidence-based IPC measures and training of healthcare workers for improving awareness on systematically following standardized protocols of Candida auris related IPC practices successfully contained Candida auris outbreaks at our hospital. This demonstrates the feasibility of establishing a multidisciplinary model and bundling of practices for preventing Candida auris outbreaks in a Low- and Middle-income country.

Expert recommendations for prevention and management of Candida auris transmission

“…In these cases, antifungal therapy is neither necessary nor useful. There are insufficient data on decolonisation 36‐39 . In the context of skin colonisation, the in vitro efficacy of preparations containing chlorhexidine has been demonstrated in some studies.…”

“…There are insufficient data on decolonisation. [36][37][38][39] In the context of skin colonisation, the in vitro efficacy of preparations containing chlorhexidine has been demonstrated in some studies. In other cases, however, pathogen persistence was reported despite multiple antiseptic washes with chlorhexidine.…”

Candida auris in skilled nursing facilities

“…Residents on Contact Precautions are restricted from leaving their rooms, except for medically necessary care, and are not allowed to participate in group activities. 59,64 The use of Enhanced Barrier Precautions, in which gown and glove are used during high-contact activities such as dressing, bathing, wound care, or changing linens, is another option for C. auris control that is resident-centered and a more practical option in the skilled nursing facility setting because residents are not restricted exclusively to their rooms and can participate in group activities. 65 In addition to implementing isolation protocols, a multifaceted approach to adopt a combination of several interventions may be required to maximize effectiveness of infection control.…”

Identification of the Most Immunoreactive Antigens of Candida auris to IgGs from Systemic Infections in Mice

“…In 2009, it was isolated for the first time from the outer ear canal of a 70-year-old woman in Japan . This emergent pathogen is multiresistant to antifungals, , difficult to diagnose, and capable of producing nosocomial outbreaks that are difficult to eradicate. − For all these reasons, the Centers for Disease Control and Prevention (CDC) has designated C. auris as the first fungal pathogen to pose a significant threat for global public health, and the World Health Organization (WHO) has included it in the critical priority group of the fungal priority pathogens list published recently…”