Management ofCandida aurisoutbreak in a tertiary-care setting in Saudi Arabia

Abstract

Objective: To describe local experience in managing an outbreak of Candida auris in a tertiary-care setting. Methods: In response to emerging Candida auris, an outbreak investigation was conducted at our hospital between March 2018 and June 2019. Once a patient was confirmed to have Candida auris, screening of exposed patients and healthcare workers (HCWs) was conducted. Postexposure screening included those who had had direct contact with or shared the same unit or ward with a laboratory-confirmed case. In response to the increasing number of cases, new infection control measures were implemented. Results: In total, 23 primary patients were detected over 15 months. Postexposure screening identified 11 more cases, and all were patients. Furthermore, ~28.6% of patients probably caught infection in another hospital or in the community. Infection control measures were strictly implemented including hand hygiene, personal protective equipment, patient hygiene, environmental cleaning, cohorting of patients and HCWs, and avoiding the sharing of equipment. The wave reached a peak in April 2019, followed by a sharp decrease in May 2019 and complete clearance in June 2019. The case patients were equally distributed between intensive care units (51.4%) and wards (48.6%). More infections (62.9%) occurred than colonizations (37.1%). Urinary tract infection (42.9%) and candidemia (17.1%) were the main infections. In total, 7 patients (20.0%) died during hospitalization; among them, 6 (17.1%) died within 30 days of diagnosis. Conclusions: Active screening of exposed patients followed by strict infection control measures, including environmental cleaning, was successful in ending the outbreak. Preventing future outbreaks is challenging due to outside sources of infection and environmental resistance.

Molecular Epidemiology of Candida Auris Outbreak in a Major Secondary-Care Hospital in Kuwait

“…C. auris has previously been isolated with increasing frequency from Kuwait [ 14 , 45 ] and other Middle Eastern countries [ 22 ], and outbreaks have also been reported recently from two other (Oman and Saudi Arabia) nearby countries [ 21 , 40 , 41 ]. These reports together with our study and various outbreaks reported recently from other geographical locations [ 3 , 6 , 21 , 30 , 33 , 36 , 37 , 38 , 39 , 40 ] strongly support the emerging role of C. auris as a major cause of invasive infections and outbreaks in health care facilities worldwide that have been difficult to control. C. auris has presumably assumed this role due to several unique characteristics.…”

“…Only 17 of 71 (24%) patients affected by the C. auris outbreak in our hospital developed candidemia. The data analyses from previous C. auris outbreaks have also shown that only a fraction (~14% to 40%) of affected patients develop candidemia [ 21 , 30 , 32 , 36 , 40 ]. The risk factors for invasive C. auris infections are similar to those for other Candida spp.…”

“…However, none of the deaths were directly attributable to C. auris infection, and use of echinocandins did not reduce skin colonization. Highly variable crude mortality rates, varying from 0% to 72%, have been observed among C. auris -infected patients, likely reflecting the highly variable patient populations in different settings with different degrees of comorbidities, particularly for ICU patients and the susceptibility patterns of infecting strains [ 6 , 19 , 21 , 29 , 30 , 31 , 32 , 36 , 40 , 41 ].…”

“…Although in the beginning only sporadic cases of invasive infections due to C. auris were detected soon after its recognition as a bloodstream pathogen, nosocomial outbreaks are now being reported with increasing frequency and involving larger patient cohorts [ 10 , 11 , 28 , 31 ]. C. auris mini/major outbreaks have been reported from the United Kingdom [ 32 , 33 ], United States of America [ 34 , 35 ], India [ 12 , 16 , 25 ], Spain [ 6 , 30 , 36 ], South Africa [ 13 ], Colombia [ 37 ], Kenya [ 38 ], Russia [ 39 ], Saudi Arabia [ 40 ] and Oman [ 21 , 41 ]. Here we describe molecular epidemiology of a nosocomial outbreak which started in the high dependency unit (HDU) of a secondary-care hospital (Farwaniya Hospital) in Kuwait with genetically identical clinical and environmental C. auris isolates.…”

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].…”