Rapid Assessment and Containment of Candida auris Transmission in Postacute Care Settings—Orange County, California, 2019

Impact of the COVID-19 Pandemic on the Clinical Profile of Candidemia and the Incidence of Fungemia Due to Fluconazole-Resistant Candida parapsilosis

“…In contrast to what has been observed in other FRCP outbreaks, candidemia due to this microorganism was not associated with increased mortality [ 10 , 24 , 29 ]. Our interpretation is that the Y132F substitution confers azole resistance but not increased virulence.…”

“…We also are unaware of whether there were any particularly contaminated areas that could have acted as a reservoir and were not adequately managed. The fact that these outbreaks tend to affect one of the ICUs more severely than other ICUs in the same institution suggests the existence of an environmental reservoir that is often very difficult to determine [ 24 , 29 , 30 ].…”

Strategies to Prevent Transmission of Candida auris in Healthcare Settings

“…Recommendations from leading experts and international health agencies advocate that detection of even a single case of C. auris should start an epidemiological investigation and implementation of infection control measures and contact precautions to prevent further transmission [ 19 ••, 84 •, 85 , 89 – 92 ]. Research has shown that delayed recognition of infection/colonization and delayed implementation of infection control practices causes rapid transmission of C. auris to other hospitalized patients sharing space and/or common facilities and equipment [ 26 •, 84 •, 85 , 93 , 94 ]. Although culture is considered the gold standard for definitive diagnosis of Candida infection, it is slow and also lacks sensitivity as nearly 50% cases of candidemia/invasive candidiasis remain culture-negative [ 95 , 96 ].…”

“…Pre-emptive screening of new patients suspected to be colonized, particularly those with international exposure or history of previous stay in a hospital with C. auris infections or with risk factors listed above, should be carried out for axilla, groin, and other relevant (urine, throat, wounds, catheter) sites [ 19 ••, 64 , 84 •, 85 , 89 ]. Considering the high frequency of skin and rectal colonization and shedding into the environment [ 19 ••, 84 •, 85 , 94 , 102 , 103 ], C. auris -positive patients should be placed in single occupancy rooms with attached toilet facilities. If this is not feasible, all C. auris -positive patients should be cohorted and cared for by a dedicated healthcare workers (HCWs) team familiar with the management of patients infected with multidrug-resistant organisms [ 19 ••, 84 •, 85 ].…”

“…Transmission of C. auris to other patients in hospital settings is largely facilitated by its ability to persist in a viable form on various environmental surfaces/equipment within the patient’s room such as walls/floors, mattresses/pillows/bed sheets, bed side trolleys, sinks, door and faucet handles, disposable/reusable equipment (oxygen mask, temperature/blood pressure monitors), and other objects (intravenous pole, personal mobile phones, cloth lanyards, etc.) 19 ••, 84 •, 85 , 89 , 94 , 102 . C. auris also survives for weeks on different environmental surfaces due to the formation of biofilms and has also been isolated from the hands/nares/groin of HCWs which could also serve as the source of its transmission to other hospitalized patients [ 19 ••, 26 •, 64 , 83 , 84 •, 85 , 104 ].…”