Successful control of Candida auris transmission in a German COVID‐19 intensive care unit

Abstract

Background Candida auris is a frequently multidrug‐resistant yeast species that poses a global health threat due to its high potential for hospital outbreaks. While C . auris has become endemic in parts of Asia and Africa, transmissions have so far rarely been reported in Western Europe except for Great Britain and Spain. We describe the first documented patient‐to‐patient transmission of C . auris in Germany in a COVID‐19 intensive care unit (ICU) and infection control measures implemented to prevent further spread of the pathogen. Methods Identification of C . auris was performed by MALDI‐TOF and confirmed by internal transcribed spacer (ITS) sequencing. Antifungal susceptibility testing was carried out. We conducted repeated cross‐sectional examinations for the presence of C . auris in the patients of the affected ICU and investigated possible routes of transmission. Results The index patient had been transferred to Germany from a hospital in Northern Africa and was found to be colonised with C . auris . The contact patient developed C . auris sepsis. Infection prevention and control (IPC) measures included strict isolation of the two C . auris patients and regular screening of non‐affected patients. No further case occurred during the subsequent weeks. Reusable blades used in video laryngoscope‐guided intubation were considered as the most likely vehicle of transmission. Conclusions In view of its high risk of transmission, vigilance regarding C . auris colonisation in patients referred from endemic countries is crucial. Strict and immediate IPC measures may have the potential to prevent C . auris outbreaks.

Expert recommendations for prevention and management of Candida auris transmission

“…While multiple outbreak descriptions exist and systematic analyses of this novel pathogen have started to shed some light on the specificities of its emergence and optimal control measures, solid evidence regarding most if not all clinically relevant interventions is still missing. Based on real‐life management of a transmission case, these recommendations were compiled to aid clinical management of C. auris transmissions in future cases 56 …”

Usefulness of screening for Candida auris colonisation in international patients admitted to a large university hospital

“…However, since the first published report more than 25 cases have been documented by the National Reference Center for Invasive Fungal Infections (NRZMyk) in Germany and only one single case of nosocomial transmission has been reported 20 . Consequently, based on our data and the current prevalence, routine C. auris screening for patients admitted with a history of previous hospitalisation abroad cannot be recommended in Germany.…”

“…Due to the large number of international patients in European hospitals C. auris could be frequently imported and pose a relevant threat to healthcare systems, as evidenced by outbreaks in Spain 17,18 or the UK. 1,19 However, since the first published report more than 25 cases have been documented by the National Reference Center for Invasive Fungal Infections (NRZMyk) in Germany and only one single case of nosocomial transmission has been reported 20 . Consequently, based on our data and the current prevalence, routine C. auris screening for patients admitted with a history of previous hospitalisation abroad cannot be recommended in Germany.…”

Increasing number of cases and outbreaks caused by Candida auris in the EU/EEA, 2020 to 2021

“…However, difficult-to-control outbreaks of C. auris have been reported in units caring for COVID-19 patients worldwide [ 10 - 13 ]. At least two of the C. auris outbreaks described in this report involved COVID-19 patients or units dedicated to the care of COVID-19 patients: the outbreak in Germany involving two cases occurred in a COVID-19 intensive care unit (ICU) [ 14 ], and an outbreak in Italy was amplified after introduction of C. auris into a COVID-19 ICU [ 3 , 15 ].…”

“…Despite the increase in the number of cases and difficult-to-control outbreaks, there are also examples from EU/EEA countries where transmission of C. auris was contained with control measures after the occurrence of only few cases, for example in Denmark and Germany [ 14 , 17 ]. National surveillance, a mycology reference laboratory that provides reference testing to hospital laboratories as well as national guidance for laboratory testing and infection control are basic elements required for the control of C. auris .…”