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Importation, Mitigation, and Genomic Epidemiology of Candida auris at a Large Teaching Hospital

Published online by Cambridge University Press:  06 December 2017

Emil P. Lesho
Affiliation:
Infectious Diseases Unit, Rochester Regional Health, Rochester, New York
Melissa Z. Bronstein
Affiliation:
Quality Safety Institute, Rochester Regional Health, Rochester, New York
Patrick McGann
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Jason Stam
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Yoon Kwak
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Rosslyn Maybank
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Jodi McNamara
Affiliation:
Nursing Division, Rochester Regional Health, Rochester, New York
Megan Callahan
Affiliation:
Nursing Division, Rochester Regional Health, Rochester, New York
Jean Campbell
Affiliation:
Microbiology and Molecular Diagnostics, Rochester Regional Health, Rochester, New York
Mary K. Hinkle
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Edward E. Walsh
Affiliation:
University of Rochester School of Medicine, Rochester, New York
Corresponding
E-mail address:

Abstract

OBJECTIVE

Candida auris (CA) is an emerging multidrug-resistant pathogen associated with increased mortality. The environment may play a role, but transmission dynamics remain poorly understood. We sought to limit environmental and patient CA contamination following a sustained unsuspected exposure.

DESIGN

Quasi-experimental observation.

SETTING

A 528-bed teaching hospital.

PATIENTS

The index case patient and 17 collocated ward mates.

INTERVENTION

Immediately after confirmation of CA in the bloodstream and urine of a patient admitted 6 days previously, active surveillance, enhanced transmission-based precautions, environmental cleaning with peracetic acid-hydrogen peroxide and ultraviolet light, and patient relocation were undertaken. Pre-existing agreements and foundational relationships among internal multidisciplinary teams and external partners were leveraged to bolster detection and mitigation efforts and to provide genomic epidemiology.

RESULTS

Candida auris was isolated from 3 of 132 surface samples on days 8, 9, and 15 of ward occupancy, and from no patient samples (0 of 48). Environmental and patient isolates were genetically identical (4–8 single-nucleotide polymorphisms [SNPs]) and most closely related to the 2013 India CA-6684 strain (~200 SNPs), supporting the epidemiological hypothesis that the source of environmental contamination was the index case patient, who probably acquired the South Asian strain from another New York hospital. All isolates contained a mutation associated with azole resistance (K163R) found in the India 2105 VPCI strain but not in CA-6684. The index patient remained colonized until death. No surfaces were CA-positive 1 month later.

CONCLUSION

Compared to previous descriptions, CA dissemination was minimal. Immediate access to rapid CA diagnostics facilitates early containment strategies and outbreak investigations.

Infect Control Hosp Epidemiol 2018;39:53–57

Type
Original Articles
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

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