Outbreak Investigation, Public Health and Health Policy
Background : Candida auris (C. auris), an emerging multi-drug resistant fungus, was first detected in New York State (NYS) in 2016. A person can be colonized with C. auris for months, contributing to environmental surface contamination within healthcare facilities (HCF) and increasing the likelihood of transmission. We describe characteristics of C. auris-colonized individuals (“surveillance cases”) in NYS HCFs to help target infection prevention recommendations.
Methods : NYSDOH investigated all individuals with suspected or confirmed C. auris and conducted case finding for colonized individuals in HCFs. Specimens were tested for C. auris by polymerase chain reaction and culture. Surveillance cases had positive C. auris cultures without evidence of clinical infection. Hospital patients and nursing home residents (“facility-based surveillance cases”) were included in the analysis of demographic and clinical data.
Results : Between 10/5/2016 and 11/7/2017, 114 facility-based surveillance cases were identified. The median age was 74 years (range 23-100 years). Facility-based surveillance cases had a median of three HCF admissions in 90 days before first positive culture (range 0-8). Ninety-three percent were from facilities in Brooklyn or Queens. Fifty-four percent had diabetes. During the week before first positive culture, 81% received mechanical ventilation, 80% had tracheostomy, and 70% had a percutaneous feeding tube. Thirty-four percent had no prior indications for Contact Precautions at time of first positive culture. To date only 9% had serial negative C. auris surveillance cultures. Sixty-two percent were known to be deceased.
Conclusions : NYSDOH identified many previously-unrecognized C. auris-colonized individuals in HCFs. They had medical comorbidities requiring invasive care and moved between multiple HCFs before their C. auris identification. HCFs should consider C. auris in their risk assessments and have a high index of suspicion for C. auris colonization among patients who have these characteristics.