Investigation of the First Seven Reported Cases of Candida auris, a Globally Emerging Invasive, Multidrug-Resistant Fungus — United States, May 2013–August 2016

Snigdha Vallabhaneni, MD; Alex Kallen, MD; Sharon Tsay, MD; Nancy Chow, PhD; Rory Welsh, PhD; Janna Kerins, VMD; Sarah K. Kemble, MD; Massimo Pacilli, MS; Stephanie R. Black, MD; Emily Landon, MD; Jessica Ridgway, MD; Tara N. Palmore, MD; Adrian Zelzany, PhD; Eleanor H. Adams, MD; Monica Quinn, MS; Sudha Chaturvedi, PhD; Jane Greenko, MPH; Rafael Fernandez, MPH; Karen Southwick, MD; E. Yoko Furuya, MD; David P. Calfee, MD; Camille Hamula, PhD; Gopi Patel, MD; Patricia Barrett; MSD; Patricia Lafaro; Elizabeth L. Berkow, PhD; Heather Moulton-Meissner, PhD; Judith Noble-Wang, PhD; Ryan P. Fagan, MD; Brendan R. Jackson, MD; Shawn R. Lockhart, PhD; Anastasia P. Litvintseva, PhD; Tom M. Chiller, MD

Disclosures

Morbidity and Mortality Weekly Report. 2016;65(44):1234-1237. 

In This Article

Discussion

C. auris is an emerging cause of Candida infections in the United States. Although the cases of C. auris described in this report appear related to isolates from South Asia and South America, available epidemiologic information suggests that most were acquired in the United States. Although transmission to patients in U.S. health care settings has not been definitively documented, several findings suggest that transmission occurred. First, whole-genome sequencing results demonstrate that isolates from patients admitted to the same hospital in New Jersey were nearly identical, as were isolates from patients admitted to the same Illinois hospital. The number of SNPs differentiating isolates from the same hospital is comparable to that detected among the multiple isolates from same patient or patient and the environment. Second, patients were colonized with C. auris on their skin and other body sites weeks to months after their initial infection, which could present opportunities for contamination of the health care environment. Third, C. auris was isolated from samples taken from multiple surfaces in one patient's health care environment, which further suggests that spread within health care settings is possible. To decrease the risk for transmission, health care personnel in acute care settings should use Standard and Contact Precautions (http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf) for patients colonized or infected with C. auris. In nursing homes, providers should consider the level of patient care being provided and the presence of transmission risk factors when deciding on the level of precautions. If such patients are transferred to other health care facilities, receiving facilities should be notified of the presence of this multidrug-resistant organism to ensure appropriate precautions are continued. Facilities should ensure thorough daily and terminal cleaning of rooms of patients with C. auris infections, including use of an EPA-registered disinfectant with a fungal claim. Facilities and laboratories are requested to continue to report cases and forward isolates of C. haemulonii and Candida spp. that are not identified further after using common laboratory identification methods to state or local health authorities and CDC, who can provide consultation about the need for additional interventions to prevent transmission.*

CDC continues to work with domestic and international partners to conduct epidemiologic studies on the emergence of this organism, risk factors for infection, and transmission mechanisms, and to evaluate the effectiveness of current infection control guidance to make additional recommendations.

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