Rapid Assessment and Containment of Candida auris Transmission in Postacute Care Settings—Orange County, California, 2019,Annals of Internal Medicine

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Rapid Assessment and Containment of Candida auris Transmission in Postacute Care Settings—Orange County, California, 2019
Annals of Internal Medicine ( IF 19.6 ) Pub Date : 2021-09-07 , DOI: 10.7326/m21-2013
Ellora N Karmarkar ₁ , Kathleen O'Donnell ₂ , Christopher Prestel ₃ , Kaitlin Forsberg ₄ , Lalitha Gade ₅ , Seema Jain ₆ , Douglas Schan ₂ , Nancy Chow ₅ , Darby McDermott ₅ , John Rossow ₃ , Mitsuru Toda ₃ , Ryan Ruiz ₇ , Sopheay Hun ₇ , Jennifer L Dale ₈ , Annastasia Gross ₈ , Tyler Maruca ₉ , Janet Glowicz ₅ , Richard Brooks ₁₀ , Hosniyeh Bagheri ₆ , Teresa Nelson ₆ , Nicole Gualandi ₅ , Zenith Khwaja ₆ , Sam Horwich-Scholefield ₆ , Josh Jacobs ₂ , Michele Cheung ₂ , Maroya Walters ₅ , Kara Jacobs-Slifka ₅ , Nimalie D Stone ₅ , Lydia Mikhail ₂ , Sudha Chaturvedi ₁₁ , Liore Klein ₉ , Paula Snippes Vagnone ₈ , Emily Schneider ₇ , Elizabeth L Berkow ₅ , Brendan R Jackson ₅ , Snigdha Vallabhaneni ₅ , Matthew Zahn ₂ , Erin Epson ₆

Affiliation

Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, and the California Department of Public Health, Richmond, California (E.N.K.).
Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.).
Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.).
Centers for Disease Control and Prevention and IHRC, Atlanta, Georgia (K.F.).
Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.).
California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.).
Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.).
Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.).
Maryland Department of Health Laboratories Administration, Baltimore, Maryland (T.M., L.K.).
Centers for Disease Control and Prevention, Atlanta, Georgia, and the Maryland Department of Health, Infectious Disease Epidemiology and Outbreak Response Bureau, Baltimore, Maryland (R.B.).
New York State Department of Health, Albany, New York (S.C.).

**Visual Abstract. Rapid Assessment and Containment ofC auris in Postacute Care Settings.**
Infection with multidrug-resistantCandida auris is a growing concern in long-term care settings. A study in California assessed the ability of rapid species identification to enhance surveillance efforts and identify gaps in infection control practices in such facilities.

Background:

Candida auris, a multidrug-resistant yeast, can spread rapidly in ventilator-capable skilled-nursing facilities (vSNFs) and long-term acute care hospitals (LTACHs). In 2018, a laboratory serving LTACHs in southern California began identifying species of Candida that were detected in urine specimens to enhance surveillance of C auris, and C auris was identified in February 2019 in a patient in an Orange County (OC), California, LTACH. Further investigation identified C auris at 3 associated facilities.

Objective:

To assess the prevalence of C auris and infection prevention and control (IPC) practices in LTACHs and vSNFs in OC.

Design:

Point prevalence surveys (PPSs), postdischarge testing for C auris detection, and assessments of IPC were done from March to October 2019.

Setting:

All LTACHs (n = 3) and vSNFs (n = 14) serving adult patients in OC.

Participants:

Current or recent patients in LTACHs and vSNFs in OC.

Intervention:

In facilities where C auris was detected, PPSs were repeated every 2 weeks. Ongoing IPC support was provided.

Measurements:

Antifungal susceptibility testing and whole-genome sequencing to assess isolate relatedness.

Results:

Initial PPSs at 17 facilities identified 44 additional patients with C auris in 3 (100%) LTACHs and 6 (43%) vSNFs, with the first bloodstream infection reported in May 2019. By October 2019, a total of 182 patients with C auris were identified by serial PPSs and discharge testing. Of 81 isolates that were sequenced, all were clade III and highly related. Assessments of IPC identified gaps in hand hygiene, transmission-based precautions, and environmental cleaning. The outbreak was contained to 2 facilities by October 2019.

Limitation:

Acute care hospitals were not assessed, and IPC improvements over time could not be rigorously evaluated.

Conclusion:

Enhanced laboratory surveillance and prompt investigation with IPC support enabled swift identification and containment of C auris.

Primary Funding Source:

Centers for Disease Control and Prevention.

中文翻译：

急性期护理机构中耳念珠菌传播的快速评估和遏制——加利福尼亚州奥兰治县，2019 年

**视觉摘要。急性期护理环境*中耳念珠菌*的快速评估和遏制。**

多重耐药*耳念珠菌*感染是长期护理机构日益关注的问题。加利福尼亚州的一项研究评估了快速物种识别的能力，以加强监测工作并找出此类设施中感染控制实践的差距。

背景：

耳念珠菌是一种多重耐药酵母菌，可以在配备呼吸机的熟练护理机构 (vSNF) 和长期急症护理医院 (LTACH) 中迅速传播。 2018 年，南加州一家为 LTACH 服务的实验室开始鉴定尿液样本中检测到的念珠菌种类，以加强对耳念珠菌的监测，并于 2019 年 2 月在加利福尼亚州奥兰治县 (OC) LTACH 的一名患者中发现了耳念珠菌。进一步调查在 3 个相关设施中发现了耳念珠菌。

客观的：

旨在评估 OC 中 LTACH 和 vSNF中耳念珠菌的患病率以及感染预防和控制 (IPC) 实践。

设计：

2019 年 3 月至 10 月进行了点患病率调查 (PPS)、耳念珠菌检测出院后检测以及 IPC 评估。

环境：

所有 LTACH ( n = 3) 和 vSNF ( n = 14) 都为 OC 成年患者提供服务。

参加者：

当前或近期患有 OC 中 LTACH 和 vSNF 的患者。

干涉：

在检测到耳念珠菌的机构中，每两周重复一次 PPS。提供持续的 IPC 支持。

测量：

抗真菌药敏试验和全基因组测序以评估分离株相关性。

结果：

17 个机构的初步 PPS 在 3 个 (100%) LTACH 和 6 个 (43%) vSNF 中发现了另外 44 名耳念珠菌患者，其中首例血流感染报告于 2019 年 5 月。截至 2019 年 10 月，共有 182 名耳念珠菌患者接受了治疗。通过系列 PPS 和放电测试进行识别。在已测序的 81 个分离株中，全部属于进化枝 III 并且高度相关。 IPC 的评估发现了手部卫生、基于传播的预防措施和环境清洁方面的差距。截至 2019 年 10 月，疫情已被控制在 2 个设施内。