Hostname: page-component-745bb68f8f-f46jp Total loading time: 0 Render date: 2025-01-08T11:50:36.020Z Has data issue: false hasContentIssue false
  • English
  • Français

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 ,
Melissa Z. Bronstein ,
Patrick McGann ,
Jason Stam ,
Yoon Kwak ,
Rosslyn Maybank ,
Jodi McNamara ,
Megan Callahan ,
Jean Campbell  and
Mary K. Hinkle
...Show all authors
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, RochesterRegional Health, Rochester, New York
Megan Callahan
Affiliation:
Nursing Division, RochesterRegional 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
*
Address correspondence to Emil Lesho, 1425 Portland Ave, Rochester, NY 14621 (carolinelesho@yahoo.com).
Get access Rights & Permissions [Opens in a new window]

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
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 1 , January 2018 , pp. 53 - 57
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Vallabhanen, S, Kallen, A, Tsay, S, et al. Investigation of the first seven reported cases of Candida auris, a globally emerging invasive, multidrug-resistant fungus—United States, May 2013–August 2016. Morb Mortal Wkly Rep 2016;65:1234–1237.Google Scholar
2. Lockhart, S, Etienne, K, Vallabhaneni, S, et al. Simultaneous emergence of multidrug-resistant Candida auris on 3 continents confirmed by whole-genome sequencing and epidemiological analyses. Clin Infect Dis 2017;64:134–140.CrossRefGoogle ScholarPubMed
3. Morales-López, SE, Parra-Giraldo, CM, Ceballos-Garzón, A, et al. Invasive infections with multidrug-resistant yeast Candida auris, Colombia. Emerg Infect Dis 2017;23:162–164.CrossRefGoogle ScholarPubMed
4. Lee, WG, Shin, JH, Uh, Y, et al. First three reported cases of nosocomial fungemia caused by Candida auris . J Clin Microbiol 2011;49:3139–3142.CrossRefGoogle ScholarPubMed
5. Satoh, K, Makimura, K, Hasumi, Y, Nishiyama, Y, Uchida, K, Yamaguchi, H. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol 2009;53:41–44.CrossRefGoogle Scholar
6. Schelenz, S, Hagen, F, Rhodes, JL, et al. First hospital outbreak of the globally emerging Candida auris in a European hospital. Antimicrob Resist . Infect Control 2016;5:35.Google Scholar
7. Sherry, L, Ramage, G, Kean, R, et al. Biofilm-forming capability of highly virulent, multidrug-resistant Candida auris . Emerg Infect Dis 2017;23:328–331.Google Scholar
8. Calvo, B, Melo, AS, Perozo-Mena, A, et al. First report of Candida auris in America: Clinical and microbiological aspects of 18 episodes of candidemia. J Infect 2016;73:369–374.CrossRefGoogle ScholarPubMed
9. Piedrahita, CT, Cadnum, JL, Jencson, AL, Shaikh, AA, Ghannoum, MA, Donskey, CJ. Environmental surfaces in healthcare facilities are a potential source for transmission of Candida auris and other Candida species. Infect Control Hosp Epidemiol 2017 Jul 11:1–3; doi: 10.1017/ice.2017.127.Google Scholar
10. Mizusawa, M, Miller, H, Green, R, et al. Can multidrug-resistant Candida auris be reliably identified in clinical microbiology laboratories? J Clin Microbiol 2017;55:638–640.Google Scholar
11. Clancy, CJ, Nguyen, MH. Emergence of Candida auris: an international call to arms. Clin Infect Dis 2017;64:141–143.Google Scholar
12. Chowdhary, A, Voss, A, Meis, JF. Multidrug-resistant Candida auris: ‘new kid on the block’ in hospital-associated infections? . J Hosp Infect 2016;94:209–212.Google Scholar
13. Clinical Alert to U.S. Healthcare Facilities—June 2016. Centers for Disease Control and Prevention website. https://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-alert.html. Published 2016. Accessed June 13, 2017.Google Scholar
14. McGann, P, Bunin, JL, Snesrud, E, et al. Real time application of whole genome sequencing for outbreak investigation—What is an achievable turnaround time? Diag Microbiol Infect Dis 2016;85:277–282.CrossRefGoogle Scholar
15. Lesho, E, Carling, P, Hosford, E, et al. Relationships between cleaning, environmental DNA, and healthcare-associated infections in a new evidence-based design hospital. Infect Control Hosp Epidemiol 2015;36:1130–1138.Google Scholar
16. Clifford, R, Sparks, M, Hosford, E, et al. Correlating cleaning thoroughness with effectiveness and briefly intervening to affect cleaning outcomes: How clean is cleaned? PLOS One 2016;11:e0155779.Google Scholar
17. Lesho, E, Waterman, P, Chukwuma, U, et al. The Antimicrobial Resistance Monitoring and Research (ARMoR) Program: The Department of Defense’s response to escalating antimicrobial resistance. Clin Infect Dis 2014;59:390–397.CrossRefGoogle Scholar
18. Flowers, SA, Colon, B, Whaley, S, Schuler, MA, Rogers, PD. Contribution of clinically derived mutations in ERG11 to azole resistance in Candida albicans . Antimicrob Agents Chemother 2015;59:450–460.Google Scholar
19. Recommendations for infection control for Candida auris. Centers for Disease Control and Prevention website. https://www.cdc.gov/fungal/diseases/candidiasis/c-auris-infection-control.html#contacts. Accessed August 8, 2017.Google Scholar
20. Interim guidance for a public health response to contain novel or targeted multidrug-resistant organisms (MDROs). Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/outbreaks/docs/Health-Response-Contain-MDRO.pdf. Accessed August 8, 2017.Google Scholar
21. Infection prevention and you. Association for Professionals in Infection Control and Epidemiology website. http://www.apic.org/Resource_/TinyMceFileManager/for_consumers/IPandYou_Bulletin_Candida_auris.pdf. Accessed August 19, 2017.Google Scholar
22. Tsay, S, Welsh, RM, Adams, EH, et al. Notes from the field: ongoing transmission of Candida auris in health care facilities—United States, June 2016–May 2017. Morb Mortal Wkly Rep 2017;66:514–515.CrossRefGoogle ScholarPubMed
23. Kim, M, Shin, JH, Sung, H, et al. Candida haemulonii and closely related species at 5 university hospitals in Korea: identification, antifungal susceptibility, and clinical features. Clin Infect Dis 2009;48:e57–e61.Google Scholar
24. David, S, Afshar, B, Mentasti, M, et al. Seeding and establishment of Legionella pneumonphila in hospitals: implications for genomic investigations of nosocomial Legionnaires’ disease. Clin Infect Dis 2017;64:1251–1259.Google Scholar
25. Beatson, SA, Bartley, PB. Diving deep into hospital-acquired Legionella pneumophila with whole-genome sequencing. Clin Infect Dis 2017;64:1260–1262.CrossRefGoogle ScholarPubMed
Supplementary material: Image

Lesho et al supplementary material

Lesho et al supplementary material 1

Download Lesho et al supplementary material(Image)
Image 810.5 KB
Supplementary material: Image

Lesho et al supplementary material

Lesho et al supplementary material 2

Download Lesho et al supplementary material(Image)
Image 88.4 KB