Identification and Control of Candida Auris Outbreak in a Hospital ICU

Candida auris fungi
Candida auris fungi
A recent outbreak of Candida auris in an ICU of the Oxford University Hospitals was determined to be primarily linked to reusable temperature probes.

A recent outbreak of Candida auris in an intensive care unit (ICU) of the Oxford University Hospitals was determined to be primarily linked to reusable temperature probes, according to a study published in The New England Journal of Medicine.  

After an outbreak of C auris infection that affected 70 patients was identified in the neuroscience ICU of the Oxford University Hospitals in the United Kingdom, an intensive environmental and patient screening program was instituted, along with guidelines for intervention. Predictors of colonization and infection were identified using multivariable logistic regression, and whole-genome sequencing was used to analyze isolates from the environment and from patients.

Sixty-six (94%) of the 70 patients identified as colonized or infected with C auris between February 2, 2015, and August 31, 2017, had been admitted to the ICU before being diagnosed. Seven patients developed invasive C auris infections.

After controlling for length of stay in the ICU along with patient laboratory results and vital signs, the primary predictors of C auris colonization or infection were reusable axillary skin-surface temperature probes (multivariable OR=6.80; 95% CI, 2.96-15.63; <.01) and systemic exposure to fluconazole (multivariable OR=10.34; 95% CI, 1.64-65.18; =.01).

C auris was not reliably detectable in the general ICU environment but was detected in isolates from reusable ICU equipment, such as the temperature probes. These isolates were determined to be genetically related to isolates taken from infected patients. Further, despite the infection-control interventions instituted, the incidence of new C auris cases was reduced only after the reusable temperature probes were removed from the ICU.

Study investigators concluded that “survival in the environment appeared to facilitate the persistence and transmission of this organism [and o]ur results indicate that reusable patient equipment may serve as a source of healthcare-associated outbreaks of infection with [C] auris.”

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Eyre DW, Sheppard AE, Madder H, et al. A Candida auris outbreak and its control in an intensive care setting [published online October 4, 2018]. N Engl J Med. doi: 10.1056/NEJMoa1714373