Postacute Care Settings in Southern California Contain C auris Outbreak

A Candida auris (C auris) outbreak at postacute care facilities in Orange County, California, was rapidly identified and contained through enhanced laboratory surveillance and the support of infection prevention and control professionals. Researchers described the intervention in an article published online ahead of print in the Annals of Internal Medicine.

“In 2018, a laboratory serving long-term acute care hospitals (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, California, LTACH,” the authors explained. “Further investigation identified C auris at three associated facilities.”

Because C auris can quickly spread in ventilator-capable skilled nursing facilities (SNFs) and LTACHs, point prevalence surveys, postdischarge testing for C auris, and infection prevention and control assessments were implemented within a month at all three of the county’s LTACHs and 14 ventilator-capable SNFs. When C auris was detected, point prevalence surveys for the multidrug-resistant yeast were repeated every 2 weeks. Infection prevention and control support was ongoing.

Initial point prevalence surveys detected C auris in 44 additional patients at all three LTACHs and at six SNFs. By May 2019, the first bloodstream infection was identified, according to the study.

Serial point prevalence surveys and discharge testing revealed a total 182 patients with C auris by October 2019. Whole-genome sequencing of 81 isolates found that all were clade III and closely related, the authors wrote.

By October 2019, the outbreak was contained to two facilities.

“Assessments of infection prevention and control [practices] identified gaps in hand hygiene, transmission-based precautions, and environmental cleaning,” the authors wrote.

Reference:
Karmarkar EN, O'Donnell K, Prestel C, et al. Rapid assessment and containment of Candida auris transmission in postacute care settings-Orange County, California, 2019. Ann Intern Med. 2021 Sep 7. doi:10.7326/M21-2013>