Quick Infection Prevention Response Stymies C. Auris

Conference | <b>Association for Professionals in Infection Control and Epidemiology (APIC)</b>

In the midst of a COVID-19 surge, a hospital was able to limit the spread of Candida auris to the initially infected patient.

COVID-19 sucked almost all the air out of any room where health care professionals might have been discussing infectious diseases—almost all the air out of the room. Despite the at first rapid and then continuous response on the part of health care systems around the world, infection preventionists (IPs) and other health care professionals did their best to monitor other deadly pathogens, such as Candida auris. As Infection Control Today® reported last November, C. auris proved to be particularly opportunistic in taking advantage of all the attention and resources thrown at COVID-19.

C. auris has been diagnosed in 40 countries since the first report about it in 2009, when clinicians found a single isolate from the discharge of the external ear canal of a 70-year-old inpatient at Tokyo Metropolitan Geriatric Hospital. By 2016, 13 cases had been identified in the United States, leading the Centers for Disease Control and Prevention (CDC) to issue interim recommendations, as well as a clinical alert, requesting laboratories to report cases and send samples to state and local health departments and the CDC.

C. auris is a fungal disease with mortality rates ranging anywhere from 30% to 60%. A study released today at the at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC) relates how one hospital handled the first occurrence of C. auris in San Diego County during the COVID-19 pandemic.

In the study, investigators with Scripps Memorial Hospital La Jolla set the scene this way: “The first known clinical case of C. auris in San Diego County was identified in an individual with recent hospitalization outside of the United States. The identification of this clinical case coincided with the first influx of COVID-19 patients.”

The patient was identified through the hospital’s carbapenemase-producing organism (CRO) screening program. When that patient tested positive for CRO, public health authorities asked that the hospital test for C. auris as well, for which the patient also tested positive. The hospital’s own microbiology laboratory also identified C. auris in the patient.

“The C. auris case prompted the implementation of a robust infection prevention plan in collaboration with PH [public health] that included isolation precautions, environmental cleaning and disinfection and education,” the study states.

The patient was hospitalized for 47 days, and the county public health department recommended that the hospital conduct C. auris colonization screening for other patients to ensure that the infection hadn’t spread.

“Neither C. auris colonization nor clinical isolates were identified in the subsequent six months,” the study states.

Investigators credit this result to a “strong infection prevention response to the C. auris case….” They concluded that “it is critical that acute-care hospitals are optimized to prevent the spread of C. auris during the COVID-19 pandemic.”

Elizabeth Jefferson, PhD, CIC, an infection preventionist in the infection prevention and clinical epidemiology department at Scripps Memorial Hospital La Jolla, wrote the study. She tells Infection Control Today® (ICT®) that “the patient had an accident in South Africa and required hospitalization for the treatment of those injuries. So as soon as a patient is identified as having health care abroad, they’re considered high risk. In our case, we screened for a carbapenemase-producing organism.”

The patient was put in isolation and screened for C. auris.

Jefferson tells ICT® that “the patient actually had to go to surgery six times. The ID physicians were able to treat Candida auris with antifungals…. Candida auris was also detected in a wound. And that was identified by our microbiology lab.”

Jefferson knew that “it just takes one case. And it’s so important to pay attention to patients’ travel histories.”

Here’s ICT®’s Q&A Elizabeth Jefferson, BS, PhD, CIC.