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Candida auris outbreak in a cardiothoracic transplant intensive care unit: implications for infection prevention practices and keeping pace with an evolving landscape

Published online by Cambridge University Press:  23 June 2025

Shardul N. Rathod Open the ORCID record for Shardul N. Rathod [Opens in a new window] ,
Grace Barajas ,
Brooks I. Mitchell ,
Michael Malczynski ,
W.Justin Moore Open the ORCID record for W.Justin Moore [Opens in a new window] ,
Erin Weslander ,
Christine Bulger ,
Andrea Stone ,
Abbas Al-Qamari  and
Christie M. Bertram
...Show all authors
Shardul N. Rathod*
Affiliation:
Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, IL, USA
Grace Barajas
Affiliation:
Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, IL, USA
Brooks I. Mitchell
Affiliation:
Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Clinical Microbiology Laboratory, Northwestern Memorial Hospital, Chicago, IL, USA
Michael Malczynski
Affiliation:
Clinical Microbiology Laboratory, Northwestern Memorial Hospital, Chicago, IL, USA
W.Justin Moore
Affiliation:
Department of Pharmacy, Northwestern Medicine, Chicago, IL, USA
Erin Weslander
Affiliation:
Department of Pharmacy, Northwestern Medicine, Chicago, IL, USA
Christine Bulger
Affiliation:
Department of Environmental Services and Patient Escort, Northwestern Memorial Hospital, Chicago, IL, USA
Andrea Stone
Affiliation:
Inpatient Cardiology Nursing Administration, Northwestern Memorial Hospital, Chicago, IL, USA
Abbas Al-Qamari
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, IL, USA Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Christie M. Bertram
Affiliation:
Department of Pharmacy, Northwestern Medicine, Chicago, IL, USA
Sarah H. Sutton
Affiliation:
Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, IL, USA Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Valentina Stosor
Affiliation:
Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Chao Qi
Affiliation:
Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Clinical Microbiology Laboratory, Northwestern Memorial Hospital, Chicago, IL, USA
Teresa R. Zembower
Affiliation:
Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, IL, USA Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Clinical Microbiology Laboratory, Northwestern Memorial Hospital, Chicago, IL, USA Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Maureen K. Bolon
Affiliation:
Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, IL, USA Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
*
Corresponding author: Shardul N. Rathod; Email: shardul.rathod@nm.org
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Abstract

Objective:

To describe the mitigation strategies for a Candida auris outbreak in a cardiothoracic transplant intensive care unit (CTICU) and its implications for infection prevention practices.

Design:

Retrospective cohort study from July 2023 to February 2024.

Setting:

A large academic medical center.

Methods:

A multidisciplinary team convened to conduct the outbreak investigation and develop mitigation strategies in the CTICU.

Results:

From July 2023 to February 2024, 34 possible hospital-onset cases of C. auris were identified in our CTICU. Whole-genome sequencing and phylogenetic analysis based on pairwise single nucleotide polymorphism (WG-SNP) distance revealed two distinct outbreak clusters. Of the 34 patients, 11 (32.3%) were solid organ transplant recipients and 12 (35.3%) had a mechanical circulatory support device. Of the cohort, only 11/34 (32.3%) had prior exposure to high-risk healthcare facilities within six months prior to admission, as follows: acute inpatient rehabilitation facilities (AIRs) (n = 5, 14.7%), skilled nursing facilities (SNFs) (n = 3, 8.8%), and long-term acute care hospitals (LTACHs) (n = 3, 8.8%). The cohort had a median of 22.0 antibiotic-days prior to their positive results. Five (14.7%) patients had C. auris candidemia, three of whom expired likely due to infection. Infection Prevention (IP) interventions addressed several modes of transmission, including healthcare personnel hands, shared patient equipment, and the environment.

Conclusion:

Our experience suggests that the epidemiology of C. auris may be changing, pointing towards a rising prevalence in acute care settings. IP interventions targeting hand hygiene behavior and promoting centralizing cleaning and disinfection of shared patient equipment may have contributed to outbreak resolution.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , First View , pp. 1 - 8
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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