Candida auris Outbreak in a COVID-19 Specialty Care Unit — Florida, July–August 2020

Molecular Epidemiological Investigation of a Nosocomial Cluster of C. auris: Evidence of Recent Emergence in Italy and Ease of Transmission during the COVID-19 Pandemic

“…Indeed, in a context where the existing ICU capacity had been overwhelmed by the large number of COVID-19 patients requiring critical care and the conventional infection prevention and control measures were challenging (e.g., cohorting), the prolonged use of personal protective equipment (PPE) by the healthcare personnel may have inadvertently mediated a silent dissemination of this fungal pathogen. Epidemiological alerts of C. auris outbreaks occurring in healthcare facilities in the context of the COVID-19 pandemic have been recently documented also in Florida, Mexico, and India [34][35][36]. Of note, these reports consistently remarked the role that a possible low compliance to the guidelines for the correct use of PPE (e.g., experienced during anticipated or existing shortages) may have played in environmental contamination and transmission of C. auris, thus providing further evidence about major risk factors likely associated with an enhanced nosocomial spread of this organism during the pandemic.…”

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

“…Studies have shown that once C. auris is introduced into a healthcare facility, it spreads rapidly among susceptible patients [40,41]. Thus far, C. auris outbreaks have been reported from the United States of America [42][43][44][45], Canada [46], Mexico [47], the United Kingdom [48,49], Spain [50,51], India [40,52], Pakistan [53], Russia [54], Saudi Arabia [55], Oman [56,57], Kuwait [58], Kenya [59], South Africa [60], and Colombia [61]. Studies describing single/multiple invasive infections and outbreaks in different countries or geographical locations in the last several years have been extensively reviewed, only some of which are cited here [29][30][31][32]38].…”

“…Although C. auris, in addition to fungemia, has also been implicated to cause ventriculitis, pericarditis, complicated pleural effusions and intra-abdominal infections, osteomyelitis, malignant otitis/otomastoiditis, meningitis and vulvovaginitis, its role in respiratory, urinary and skin and soft tissue infections remains uncertain [30,33,34,43,48,50,60,74,89,139,167,168]. Due to its multidrug-resistant nature and extraordinary ability to spread rapidly in healthcare facilities causing outbreaks with associated high mortality rates [30,[42][43][44][45][51][52][53][54][55][56][57][58], the detection of even a single case of C. auris should trigger an epidemiological investigation and the implementation of infection control measures and contact precautions to prevent further transmission [77,78,141]. This requires the capacity of hospital microbiology laboratory to efficiently and correctly identify C. auris and, following the detection of positive cases, the institution of robust infection control measures which include alerting treating infectious disease specialists and notification to institutional authorities for setting up outbreak management teams.…”

Rapid Spread and Control of Multidrug-Resistant Gram-Negative Bacteria in COVID-19 Patient Care Units

“…Prolonged critical illness, high antibiotic and corticosteroid use, double occupancy, the team nursing model, and modified infection prevention practice were considered contributors to transmission, underscoring the importance of vigilance to MDR organisms in this setting (5,(7)(8)(9)(10). Surveillance culturing aided with recognizing the extent of spread and informed early intervention.…”