1
|
McDougal AN, DeMaet MA, Garcia B, York T, Iverson T, Ojo O, Patel J. A cluster investigation of Candida auris among hospitalized incarcerated patients. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e244. [PMID: 38156225 PMCID: PMC10753478 DOI: 10.1017/ash.2023.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 12/30/2023]
Abstract
Objective Investigate and mitigate a cluster of Candida auris cases among incarcerated patients in a maximum-security prison hospital utilizing contact tracing, screening, whole genome sequencing, and environmental sampling and decontamination. Design Outbreak investigation. Setting Inpatient prison hospital affiliated with an academic tertiary referral center. Patients Inmates of the Texas Department of Criminal Justice. Methods Epidemiologic and environmental investigations were conducted including contact tracing, point prevalence surveys, and environmental sampling. Whole genome sequencing was performed on positive patient isolates. Results Following a clinical case of C. auris fungemia, 344 patients underwent C. auris surveillance screening. Eight (2.3%) patients were identified with C. auris colonization. All patients were male. Our index patient was the only clinical case and death. Whole genome sequencing was performed on the nine patient isolates. All isolates were clade III (Africa) and clustered together with the largest SNP difference being 21. Environmental cultures from 7 of 61 rooms (11.5%) were positive following terminal disinfection with bleach. Sites nearest to the patient were most often positive including the hospital bed rails and bedside table. The transmission cluster was successfully mitigated within 60 days of identification. Conclusions Implementation of an aggressive surveillance and decontamination program resulted in mitigation of a C. auris transmission cluster among our incarcerated patients. This investigation provides valuable insight into C. auris transmission in the incarcerated population, which is not considered a classic high-risk population as well as the challenges faced to stop transmission in a facility that requires the use of shared patient environments.
Collapse
Affiliation(s)
- April N. McDougal
- Department of Infection Control and Healthcare Epidemiology, University of Texas Medical Branch, Galveston, TX, USA
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Mary Ann DeMaet
- Department of Infection Control and Healthcare Epidemiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Bobbiejean Garcia
- Healthcare Safety Unit, Texas Department of State Health Services, Austin, TX, USA
| | - Teresa York
- Department of Infection Control and Healthcare Epidemiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Thomas Iverson
- Utah Department of Health and Human Services, Salt Lake City, UT, USA
| | - Olugbenga Ojo
- Division of General Internal Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Texas Department of Criminal Justice Hospital & Clinics, Galveston, TX, USA
| | - Janak Patel
- Department of Infection Control and Healthcare Epidemiology, University of Texas Medical Branch, Galveston, TX, USA
- Division of Infectious Disease, Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
2
|
Garcia-Bustos V, Cabanero-Navalon MD, Ruiz-Saurí A, Ruiz-Gaitán AC, Salavert M, Tormo MÁ, Pemán J. What Do We Know about Candida auris? State of the Art, Knowledge Gaps, and Future Directions. Microorganisms 2021; 9:2177. [PMID: 34683498 PMCID: PMC8538163 DOI: 10.3390/microorganisms9102177] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022] Open
Abstract
Candida auris has unprecedently emerged as a multidrug resistant fungal pathogen, considered a serious global threat due to its potential to cause nosocomial outbreaks and deep-seated infections with staggering transmissibility and mortality, that has put health authorities and institutions worldwide in check for more than a decade now. Due to its unique features not observed in other yeasts, it has been categorised as an urgent threat by the Centers for Disease Control and Prevention and other international agencies. Moreover, epidemiological alerts have been released in view of the increase of healthcare-associated C. auris outbreaks in the context of the COVID-19 pandemic. This review summarises the current evidence on C. auris since its first description, from virulence to treatment and outbreak control, and highlights the knowledge gaps and future directions for research efforts.
Collapse
Affiliation(s)
- Victor Garcia-Bustos
- Department of Internal Medicine and Infectious Diseases, University and Polytechnic La Fe Hospital, 56026 Valencia, Spain;
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (A.C.R.-G.); (M.Á.T.); (J.P.)
- Department of Pathology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain;
| | - Marta D. Cabanero-Navalon
- Department of Internal Medicine and Infectious Diseases, University and Polytechnic La Fe Hospital, 56026 Valencia, Spain;
| | - Amparo Ruiz-Saurí
- Department of Pathology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain;
| | - Alba C. Ruiz-Gaitán
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (A.C.R.-G.); (M.Á.T.); (J.P.)
| | - Miguel Salavert
- Department of Internal Medicine and Infectious Diseases, University and Polytechnic La Fe Hospital, 56026 Valencia, Spain;
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (A.C.R.-G.); (M.Á.T.); (J.P.)
| | - María Á. Tormo
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (A.C.R.-G.); (M.Á.T.); (J.P.)
| | - Javier Pemán
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (A.C.R.-G.); (M.Á.T.); (J.P.)
- Department of Medical Microbiology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| |
Collapse
|
3
|
Sood G, Perl TM. Outbreaks in Health Care Settings. Infect Dis Clin North Am 2021; 35:631-666. [PMID: 34362537 DOI: 10.1016/j.idc.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Outbreaks and pseudo-outbreaks in health care settings are complex and should be evaluated systematically using epidemiologic and molecular tools. Outbreaks result from failures of infection prevention practices, inadequate staffing, and undertrained or overcommitted health care personnel. Contaminated hands, equipment, supplies, water, ventilation systems, and environment may also contribute. Neonatal intensive care, endoscopy, oncology, and transplant units are areas at particular risk. Procedures, such as bronchoscopy and endoscopy, are sources of infection when cleaning and disinfection processes are inadequate. New types of equipment can be introduced and lead to contamination or equipment and medications can be contaminated at the manufacturing source.
Collapse
Affiliation(s)
- Geeta Sood
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower, 3rd Floor, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Y7;302, Dallas, TX 75390, USA
| |
Collapse
|
4
|
Abstract
Introduction: Invasive fungal infection carries a high morbidity, mortality and economic cost. In recent times, a rising incidence of fungal infection and antifungal resistance is occurring which has prompted the development of novel antifungal agents.Areas covered:In this perspective, the authors describe the current status of registered antifungals and their limitations in the treatment of invasive fungal infection. They also go on to describe the new antifungal agents that are in the clinical stage of development and how they might be best utilized in patient care in the future.Expert opinion: The antifungal drug development pipeline has responded to a growing need for new agents to effectively treat fungal disease without concomitant toxicity or issues with drug tolerance. Olorofim (F901318), ibrexafungerp (SCY-078), fosmanogepix (APX001), rezafungin (CD101), oteseconazole (VT-1161), encochleated amphotericin B (MAT2203), nikkomycin Z (NikZ) and ATI-2307 are all in the clinical stage of development and offer great promise in offering clinicians better agents to treat these difficult infections.
Collapse
Affiliation(s)
- Adam G Stewart
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
| | - David L Paterson
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
| |
Collapse
|
5
|
Alvarado-Socarras JL, Vargas-Soler JA, Franco-Paredes C, Villegas-Lamus KC, Rojas-Torres JP, Rodriguez-Morales AJ. A Cluster of Neonatal Infections Caused by Candida auris at a Large Referral Center in Colombia. J Pediatric Infect Dis Soc 2021; 10:549-555. [PMID: 33528008 DOI: 10.1093/jpids/piaa152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/18/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Globally, Candida auris is an emerging pathogen that poses an essential threat in healthcare settings presenting as outbreaks requiring significant allocation of infection control interventions to curb transmission. This fungal pathogen was initially identified in 2009 in Japan, but it has spread to all continents. Candida auris poses significant diagnostic and treatment challenges. Conventional microbiology laboratories often misidentify this pathogen as Candida haemulonii or as other Candida spp., Rhodoturola glutinis, and even with some bacterial pathogens, including Neisseria meningitidis serogroup A. Furthermore, C. auris displays distinct mechanisms of antifungal resistance to azoles and amphotericin B formulations. Most of the case series and outbreak reports have included invasive infections in adult populations. METHODS Herein, we present a cluster of neonatal infections caused by Candida auris at a large referral center in Colombia. RESULTS We report a case series of 8 neonates and infant patients who were seen at a large referral center in Colombia and who develop invasive infections caused by C. haemulonii and C. auris. DISCUSSION Our report highlights the diagnostic challenges in identifying this fungal pathogen correctly, its clinical spectrum of disease, recommendations for empiric antifungal therapy, and it is not always associated with a high case fatality rate.
Collapse
Affiliation(s)
| | | | - Carlos Franco-Paredes
- Anschutz Medical Center, University of Colorado, Aurora, Colorado, USA.,Hospital Infantil de México Federico Gomez, México City, México
| | | | | | - Alfonso J Rodriguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia.,Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Americas, Pereira, Colombia.,Universidad Privada Franz Tamayo (UNIFRANZ), Cochabamba, Bolivia
| |
Collapse
|
6
|
Carvajal SK, Alvarado M, Rodríguez YM, Parra-Giraldo CM, Varón C, Morales-López SE, Rodríguez JY, Gómez BL, Escandón P. Pathogenicity Assessment of Colombian Strains of Candida auris in the Galleria mellonella Invertebrate Model. J Fungi (Basel) 2021; 7:jof7060401. [PMID: 34063862 PMCID: PMC8223996 DOI: 10.3390/jof7060401] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023] Open
Abstract
Candida auris, first described in 2009, is an opportunistic pathogenic yeast that causes nosocomial outbreaks around the world, with high mortality rates associated with therapeutic failure. In this study, we evaluated the pathogenicity of 107 isolates from two cities in Colombia, associated with fungemia or colonization processes; to achieve this, we used the Galleria mellonella invertebrate model to compare pathogenicity. Our results showed that less than half of the total isolates of C. auris presented a high pathogenicity compared to the reference strain SC5314, and most of those highly pathogenic strains were from colonization processes. We observed that there was formation of large aggregates of cells that cannot be disrupted easily, without statistically significant differences between the pathogenicity of the aggregated and non-aggregated strains. In addition, protease activity was observed in 100% of the C. auris strains; phospholipase and hemolysin activity were observed in 67.3 and 68.2% of the studied strains, respectively. In conclusion, these results highlight the utility of determining survival using G. mellonella, which allowed us to provide new information on the pathogenicity, enzymatic activity, and the relationship of the aggregated and non-aggregated phenotypes of C. auris in this model.
Collapse
Affiliation(s)
- Silvia Katherine Carvajal
- Grupo de Microbiología, Instituto Nacional de Salud, Bogota 111321, Colombia; (S.K.C.); (M.A.)
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Unidad de Proteómica y Micosis Humanas, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogota 110231, Colombia;
| | - Maira Alvarado
- Grupo de Microbiología, Instituto Nacional de Salud, Bogota 111321, Colombia; (S.K.C.); (M.A.)
| | - Yuli M. Rodríguez
- Bacteriología y Laboratorio Clínico, Universidad Colegio Mayor de Cundinamarca, Bogotá 111311, Colombia;
| | - Claudia M. Parra-Giraldo
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Unidad de Proteómica y Micosis Humanas, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogota 110231, Colombia;
| | - Carmen Varón
- Hospital Infantil Napoleón Franco Pareja, Cartagena 130010, Colombia;
| | - Soraya E. Morales-López
- Grupo CINBIOS, Departamento de Microbiología, Universidad Popular del Cesar, Valledupar 200004, Colombia;
| | - José Y. Rodríguez
- Centro de Investigaciones Microbiológicas del Cesar, Valledupar 200002, Colombia;
- Clínica Alta Complejidad, Valledupar 200002, Colombia
- Clínica Laura Daniela, Valledupar 200002, Colombia
- Instituto Cardiovascular del Cesar, Valledupar 200002, Colombia
| | - Beatriz L. Gómez
- Translational Microbiology and Emerging Diseases (MICROS), School of Medicine and Health Sciences, Universidad del Rosario, Bogota 111221, Colombia;
| | - Patricia Escandón
- Grupo de Microbiología, Instituto Nacional de Salud, Bogota 111321, Colombia; (S.K.C.); (M.A.)
- Correspondence: ; Tel.: +57-1-2207700 (ext. 1558)
| |
Collapse
|
7
|
Evaluation of Synergistic Activity of Isavuconazole or Voriconazole plus Anidulafungin and the Occurrence and Genetic Characterization of Candida auris Detected in a Surveillance Program. Antimicrob Agents Chemother 2021; 65:AAC.02031-20. [PMID: 33431416 DOI: 10.1128/aac.02031-20] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/19/2020] [Indexed: 12/27/2022] Open
Abstract
A total of 15 Candida auris isolates from the SENTRY antimicrobial surveillance program between 2006 and 2019 were combined with 21 isolates from other collections for the evaluation of antifungal susceptibility and synergy against anidulafungin plus voriconazole or isavuconazole using the checkerboard method. Surveillance isolates were analyzed for genetic relatedness and resistance mechanisms. Applying the tentative statistical epidemiological cutoff values and the Centers for Disease Control tentative breakpoints, 32/36 isolates were resistant to fluconazole, 5/36 were resistant to amphotericin B, 5/36 were non-wild-type (NWT) to anidulafungin, 3/36 were NWT to micafungin, and 1/36 and 10/36 were NWT to isavuconazole and voriconazole, respectively. Of these, 10 isolates were multidrug resistant, which means that these isolates were resistant to 2 antifungal classes. Synergy or partial synergy was noted in 5/36 and 22/36, respectively, of the isolates with the combination of anidulafungin plus voriconazole, and 11/36 and 19/36 isolates, respectively, for the combination of anidulafungin plus isavuconazole. Multilocus sequence type (MLST) analysis of the 15 SENTRY isolates demonstrated that the isolates from the US were genetically related to, but different from, isolates from Latin America (Panama and Colombia) and Germany. Single nucleotide polymorphism (SNP) analysis showed that the 15 SENTRY isolates belonged to the described international clades and had associated Erg11 alterations, including 11 isolates displaying K143R, one displaying F126L, and one displaying Y501H alterations and a fluconazole MIC result of ≥64 mg/liter. Resistance mechanisms were not observed in the two isolates displaying fluconazole MIC values at 4 and 16 mg/liter. Isavuconazole displayed activity and greater synergy when tested with anidulafungin than seen with anidulafungin plus voriconazole against the C. auris clinical isolates that displayed resistance phenotypes.
Collapse
|
8
|
Shah S, Shelburne S. Skin and Soft Tissue Infections in Non-Human Immunodeficiency Virus Immunocompromised Hosts. Infect Dis Clin North Am 2020; 35:199-217. [PMID: 33303336 DOI: 10.1016/j.idc.2020.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Skin and soft tissue infections among the non-human immunodeficiency virus infected immunosuppressed population are a serious and growing concern. Many pathogens can cause cutaneous infections in these patients owing to the highly varied and profound immune deficits. Although patients can be infected by typical organisms, the diversity and antimicrobial-resistant nature of the organisms causing these infections result in significant morbidity and mortality. The diagnostic approach to these infections in immunocompromised hosts can differ dramatically depending on the potential causative organisms. An understanding of new immunosuppressive treatments and evolving antimicrobial resistance patterns are required to optimally manage these difficult cases.
Collapse
Affiliation(s)
- Shivan Shah
- Department of Infectious Diseases, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 1460, Houston, TX 77030, USA
| | - Samuel Shelburne
- Department of Infectious Diseases, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 1460, Houston, TX 77030, USA.
| |
Collapse
|
9
|
Clade-specific variation in susceptibility of Candida auris to broad-spectrum ultraviolet C light (UV-C). Infect Control Hosp Epidemiol 2020; 41:1384-1387. [PMID: 33046172 PMCID: PMC7720409 DOI: 10.1017/ice.2020.410] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Candida auris is an emerging and often multidrug-resistant fungal pathogen with an exceptional ability to persist on hospital surfaces. These surfaces can act as a potential source of transmission. Therefore, effective disinfection strategies are urgently needed. We investigated the efficacy of ultraviolet C light (UV-C) disinfection for C. auris isolates belonging to 4 different clades. Methods: In vitro testing of C. auris isolates was conducted using 106 colony-forming units (CFU) spread on 20-mm diameter steel carriers and exposed to a broad-spectrum UV-C light source for 10, 20, and 30 minutes at a 1.5 m (5 feet) distance. Post-UV survivors on the coupons were subsequently plated. Colony counts and log reductions were recorded, calculated, and compared to untreated control carriers. Identification of all isolates were confirmed by MALDI-TOF and morphology was visualized by microscopy. Results: We observed an increased susceptibility of C. auris to UV-C in 8 isolates belonging to clades I, II and IV with increasing UV exposure time. The range of log kill (0.8–1.19) was highest for these isolates at 30 minutes. But relatively no change in log kill (0.04–0.35) with increasing time in isolates belonging to clade III were noted. Interestingly, C. auris isolates susceptible to UV-C were mostly nonaggregating, but the isolates that were more resistant to UV exposure formed aggregates. Conclusions: Our study suggests variability in susceptibility to UV-C of C. auris isolates belonging to different clades. More studies are needed to assess whether a cumulative impact of prolonged UV-C exposure provides additional benefit.
Collapse
|
10
|
Management of Candida auris outbreak in a tertiary-care setting in Saudi Arabia. Infect Control Hosp Epidemiol 2020; 42:149-155. [PMID: 32880247 DOI: 10.1017/ice.2020.414] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe local experience in managing an outbreak of Candida auris in a tertiary-care setting. METHODS In response to emerging Candida auris, an outbreak investigation was conducted at our hospital between March 2018 and June 2019. Once a patient was confirmed to have Candida auris, screening of exposed patients and healthcare workers (HCWs) was conducted. Postexposure screening included those who had had direct contact with or shared the same unit or ward with a laboratory-confirmed case. In response to the increasing number of cases, new infection control measures were implemented. RESULTS In total, 23 primary patients were detected over 15 months. Postexposure screening identified 11 more cases, and all were patients. Furthermore, ~28.6% of patients probably caught infection in another hospital or in the community. Infection control measures were strictly implemented including hand hygiene, personal protective equipment, patient hygiene, environmental cleaning, cohorting of patients and HCWs, and avoiding the sharing of equipment. The wave reached a peak in April 2019, followed by a sharp decrease in May 2019 and complete clearance in June 2019. The case patients were equally distributed between intensive care units (51.4%) and wards (48.6%). More infections (62.9%) occurred than colonizations (37.1%). Urinary tract infection (42.9%) and candidemia (17.1%) were the main infections. In total, 7 patients (20.0%) died during hospitalization; among them, 6 (17.1%) died within 30 days of diagnosis. CONCLUSIONS Active screening of exposed patients followed by strict infection control measures, including environmental cleaning, was successful in ending the outbreak. Preventing future outbreaks is challenging due to outside sources of infection and environmental resistance.
Collapse
|