March 16, 2021
In January 2021, Candida auris became a Texas
notifiable condition with required isolate submission to the DSHS Laboratory in
Austin. Since it became reportable, seven cases of C. auris have been
reported in Texas residents. Two of these cases were identified as resistant to
all three classes of antifungal drug. These are the first cases of pan-resistant
C. auris identified in Texas. This Health Advisory is intended to
provide recommendations regarding laboratory identification methods,
treatment options and infection control recommendations to mitigate C. auris transmission.
About Candida auris
Candida auris is a fungus that may
cause serious illness for those it infects. C. auris can cause invasive
infections, including bloodstream infections, which may result in death,
particularly in hospital and long-term care patients. C. auris is a
public health threat because it is often multidrug-resistant, is difficult to
identify, and can persist on surfaces in healthcare environments, resulting in the
spread of C. auris among patients in healthcare facilities. Patients
exposed to C. auris may remain
colonized for a long time, putting them at risk for a future C. auris infection and further spreading
the fungus.
Laboratory Identification
If C. auris infection is suspected, ask the
testing laboratory to keep all isolates. C. auris can be misidentified
in the laboratory when using traditional phenotypic methods for yeast
identification such as VITEK 2 YST, API 20C, BD Phoenix yeast identification
system, and MicroScan. CDC provides guidance on common misidentifications by
identification method via this link: https://www.cdc.gov/fungal/candida-auris/identification.html.
All C. auris isolates and any Candida
isolates that may be misidentified or cannot be identified may be referred to
the DSHS Laboratory. Instructions on shipping C. auris isolates can be
found on the DSHS Laboratory webpage via this link: https://www.dshs.texas.gov/lab/ARLN/ShippingCANDIDAISOLATES.shtm.
Infection Control Recommendations
To mitigate transmission of C. auris in healthcare settings, implement the following
recommendations for inpatient settings:
- Place
the patient in a single-patient room and use Standard and Contact
Precautions.
- Emphasize
adherence to hand hygiene.
- C.
auris can persist on surfaces in healthcare
environments. Clean and disinfect the patient care environment (daily and
terminal cleaning) and patient care equipment with an Environmental
Protection Agency (EPA)-registered hospital-grade disinfectant effective against
C. auris or Clostridium
difficile spores (List K).
- Use
dedicated equipment, whenever possible. Clean and disinfect any reusable
equipment that is used on the infected/colonized individual after each
use. Shared equipment (e.g., ventilators, physical therapy equipment)
should also be cleaned and disinfected before use by another patient.
- Flag
the patient’s Electronic Medical Record so appropriate infection control
measures including contact precautions can be implemented.
- Upon
patient transfer, inform the accepting facility of the C. auris
colonization or infection history and the level of isolation needed.
- Screen
close healthcare contacts of newly identified patient(s) with C. auris
infection or colonization for presence of colonization.
The CDC has developed infection control
recommendations and educational materials for healthcare settings, patients and
family members. Please see additional recommendations at https://www.cdc.gov/fungal/candida-auris/c-auris-infection-control.html.
Treatment
- Multidrug-resistance
is common with C. auris. Most strains of C. auris found in
the United States have been susceptible to echinocandins. Patients on
antifungal treatment should be carefully monitored for clinical
improvement and follow-up cultures with susceptibility testing should be
conducted.
- CDC
has developed specific treatment guidelines for adults, infants, and
neonates. These are available at https://www.cdc.gov/fungal/diseases/candidiasis/c-auris-treatment.html.
- CDC
does not recommend treatment of C.
auris cultured from noninvasive sites when there is no evidence of
infection.
For more information,
healthcare providers can contact their local health department: http://www.dshs.state.tx.us/idcu/investigation/conditions/contacts/.