Factors Associated With Candida auris Colonization and Transmission in Skilled Nursing Facilities With Ventilator Units, New York, 2016–2018

Abstract

Background Candida auris is an emerging, multidrug-resistant yeast that spreads in healthcare settings. People colonized with C. auris can transmit this pathogen and are at risk for invasive infections. New York State (NYS) has the largest U.S. burden (>500 colonized and infected people); many colonized individuals are mechanically ventilated or have tracheostomy and are residents of ventilator-capable skilled nursing facilities (vSNF). We evaluated factors associated with C. auris colonization among vSNF residents to inform prevention interventions. Methods During 2016–2018, the NYS Department of Health conducted point prevalence surveys (PPS) to detect C. auris colonization among residents of vSNFs. In a case-control investigation, we defined a case as C. auris colonization in a resident and identified up to four residents with negative swabs during the same PPS as controls. We abstracted data from medical records on facility transfers, antimicrobials, and medical history. Results We included 60 cases and 218 controls identified from 6 vSNFs. After controlling for potential confounders, the following characteristics were associated with C. auris colonization: being on a ventilator (aOR: 5.9; CI: 2.3–15.4), receiving carbapenem antibiotics in the prior 90 days (aOR: 3.5; CI: 1.6–7.6), having ≥1 acute care hospital visit in the prior six months (aOR: 4.2; CI: 1.9–9.6), and receiving systemic fluconazole in the prior 90 days (aOR: 6.0; CI: 1.6–22.6). Conclusions Targeted screening of patients in vSNFs with the above risk factors for C. auris can help identify colonized patients and facilitate implementation of infection control measures. Antimicrobial stewardship may be an important factor in the prevention of C. auris colonization.

Colonisation and Transmission Dynamics of Candida auris among Chronic Respiratory Diseases Patients Hospitalised in a Chest Hospital, Delhi, India: A Comparative Analysis of Whole Genome Sequencing and Microsatellite Typing

“…It is known that the rates of culture positive surveillance cases of C. auris varies in different healthcare facilities depending on the facility type. Previously, a contact tracing and epidemiologic investigation surrounding cases earlier in the C. auris epidemic in New York revealed that colonisation rates varied by facility type, i.e., hospitals (5%), long term care facilities (LTCF, 6.3%), long term acute care (2.9%), and co-located hospital and LTCF (12.3%) [ 38 ]. C. auris colonisation rates in skilled nursing facilities that cared for ventilated patients were nearly ten times higher than the prevalence in skilled nursing facilities that did not provide care for ventilated residents [ 38 , 39 ].…”

“…Previously, a contact tracing and epidemiologic investigation surrounding cases earlier in the C. auris epidemic in New York revealed that colonisation rates varied by facility type, i.e., hospitals (5%), long term care facilities (LTCF, 6.3%), long term acute care (2.9%), and co-located hospital and LTCF (12.3%) [ 38 ]. C. auris colonisation rates in skilled nursing facilities that cared for ventilated patients were nearly ten times higher than the prevalence in skilled nursing facilities that did not provide care for ventilated residents [ 38 , 39 ]. It is pertinent to emphasize that colonisation by C. auris predisposes patients at risk for invasive infection as 5–10% of known colonised patients have been reported to develop invasive infections [ 10 ].…”

Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal Susceptibility, and Infection Control Measures to Combat the Spread of Infections in Healthcare Facilities

“…are part of the microbiome in humans [1,2,172]. C. auris is highly transmissible among patients, likely due to its tendency to persistently colonize skin and other body sites and is shed into the environment [30,38,41,58,75,[79][80][81]. Patients undergoing invasive procedures or the placement of invasive devices are at greater risk of acquiring C. auris bloodstream infection with catheters providing an easy access for the fungus to enter bloodstream [38,40].…”

“…The shedding of C. auris from colonized patients and its transmissibility to other patients in critical care settings within hospitals has been fairly established, and the transmission is facilitated largely due to this organism's ability to persist in a viable form in the environment around the patient [38,41,48,58,[79][80][81]. Viable C. auris cells have also been recovered from various environmental sources within the patient's room/bathroom including beds, bedding materials (mattresses, pillows and bed sheets), bed side trolley, floors, sinks, bathroom door and faucet handles, bathroom walls, medical equipment and disposable/reusable equipment such as oxygen mask, axillary temperature probes and intravenous pole as well as personal mobile phones [48,58,68,69,79].…”

Regional spread of blaNDM-1-containing Klebsiella pneumoniae Sequence Type 147 in post-acute care facilities

“…There are several factors that likely contributed to the spread of this NDM+ ST147 clone. First, vSNF patients are a high-risk population for carriage of CRE as they are chronically ill, are usually admitted from ICUs or LTACHs, and are often exposed to antibiotics [65]. Second, patients in vSNFs generally have long lengths of stay — often much longer than patient stays at LTACHs [66] — meaning that they have a longer period of time to acquire a multi-drug resistant organism.…”