C auris: CDC Warns of Institutional Spread, Updates Guidance

Janis C. Kelly

May 18, 2017

The emerging and often drug-resistant fungus Candida auris continues to spread in the United States, the Centers for Disease Control and Prevention (CDC) reported today. Less than a year after the first seven cases of C auris were reported in the United States, the agency now says there have been 77 patient cases, and another 45 cases have been identified via close-contact screening through May 12, 2017.

The report, published May 19 in Morbidity and Mortality Weekly Report, also provides updated recommendations for reducing the spread of C auris, with a new emphasis on interrupting transmission within healthcare facilities. This change reflects new data on environmental contamination and the risk for C auris transmission among close contacts, such as patients on the same ward.

Of the 122 cases, most were from healthcare facilities in three geographic areas, New York, New Jersey, and Illinois. Most patients were chronically ill and had long stays at high-acuity skilled nursing facilities, such as those providing mechanical ventilation, Sharon Tsay, MD, from the CDC's National Center for Emerging and Zoonotic Infectious Diseases, and colleagues report.

The heightened attention to the emergence of C auris infections in healthcare facilities reflects the fact that the fungus is often multidrug resistant and has an associated mortality rate of 60%. CDC analysis of the first 35 clinical isolates showed that 86% were resistant to fluconazole, 43% were resistant to amphotericin B, and 3% were resistant to echinocandins.

The researchers uncovered epidemiologic links between most of the clinical cases. "In Illinois, three cases were associated with the same long-term care facility. In New York and New Jersey, cases were identified in multiple acute care hospitals, but further investigation found most had overlapping stays at interconnected long-term care facilities and acute care hospitals within a limited geographic area. The case in Massachusetts was linked to the Illinois cases."

Screening of 390 close contacts, using a composite swab of the groin and axilla, showed that 12% were colonized by C auris. Testing of patients' rooms also recovered C auris from "mattresses, beds, windowsills, chairs, infusion pumps, and countertops.... C auris was not isolated from rooms after thorough cleaning with a sodium hypochlorite–based disinfectant."

On the basis of these findings, the agency now recommends the use of standard and contact precautions for all infected and colonized patients. In addition, patients should be housed in private rooms, and patients' rooms should undergo daily and terminal cleaning "with a disinfectant active against Clostridium difficile spores (an update from previous disinfectant recommendations)." In addition, receiving healthcare facilities should be notified before a patient with C auris colonization or infection is transferred.

Dr Tsay and colleagues note that differences among the C auris isolates from New York, New Jersey, and Illinois indicate multiple introductions of C auris into the United States from South Asia and South America, followed by local transmission.

The authors conclude, "Ongoing investigation of US C auris cases provides epidemiologic and laboratory data suggesting that this fungus can spread within health care facilities and that interventions are needed to prevent transmission during this early stage of C auris emergence."

The authors have disclosed no relevant financial relationships.

MMWR Morbid Mortal Wkly Rep. 2017;66:514-515. Full text

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