Screening at Seattle Hospital Illustrates a Candida auris Outbreak

Last week, Seattle health officials confirmed the fourth case of the fungal infection, Candida auris (C auris), in a local hospital, Kindred Hospital Seattle, according to Public Health Seattle and King County.¹

This fourth case that had links to Kindred hospital was reported on January 26. The very first case was discovered just weeks before on January 10 in a patient who was admitted to the hospital. Additional screening of other patients found 2 new positive C auris cases on January 22.¹ These patients had previously tested negative for C auris when they were first admitted. This is the first known outbreak of C auris in Washington state.

It is important to note, that C auris typically affects older patients with comorbidities.

“Most healthy people do not need to worry about C auris infections,” Claire Brostrom-Smith, manager of the Healthcare Associated Infections Program at Public Health Seattle and King County, said in a statement. “The risk is mainly for patients that have long stays at hospitals and need medical interventions like breathing tubes, feeding tubes or urinary catheters.”¹

Incidence Rates are Increasing, Multidrug Resistance (MDR) Continues

C auris continues to see an increase in incidence rates, with a 95% increase in cases during 2020-2021. And over the last 5 years, CDC has tracked cases using the Premier Healthcare database, which is a comprehensive electronic healthcare data repository, and offers insights on hospitalizations.²

Last year, the CDC’s publication, Emerging Infectious Diseases, published data looking at patterns with these patients. From 2017–2022, they examined 192 cases of C auris and offered data on these hospitalizations. Investigators examined features of C auris hospitalizations and compared those those without bloodstream infections (BSI). Within the study there were 38 (20%) C auris BSI. The authors noted that consistent with treatment guidelines, most BSI hospitalizations involved echinocandin therapy. “Echinocandin use was more frequent for bloodstream (76%) versus nonbloodstream (25%) hospitalizations; median time from first positive culture to echinocandin use was 2 days (interquartile range 1–3 days),” they wrote.²

Typically the first-line of therapy for C auris is echinocandins, and the fungal infection is proving to be multidrug resistant with this drug class, which can lead to increased mortality if there is treatment failure overall.

In the aforementioned study, C auris had a high mortality rate. “Including in-hospital deaths and discharges to hospice, the overall estimated crude mortality rate of 34% (47% for BSI) was similar to the 30-day mortality rate from a previous study in New York (27% overall and 39% for BSI),” the investigators wrote.³

Screening

From a public health standpoint, there is concern about growing cases, MDR, and mortality rates. However, stakeholders are aware of preventative strategies and stress the significance of testing and infection prevention controls.

For example, the C auris cases in Seattle were identified as a result of a screening program called the Partners for Patient Safety Program. Through the program, all patients at the hospital are screened at the time of their admission to the facility.

The intent of the program is to detect cases early-on to help prevent spread. Screening is a significant strategy because patients can often be asymptomatic but can still transmit C auris to other patients.

“Health care facilities that provide screening are taking an important proactive step to identify cases early-on to reduce the risk of spread to other patients,” Brostrom-Smith said.

Meghan Lyman, MD, medical officer, Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), and her colleagues coauthored a study, which was published in the Annals of Internal Medicine last year looking at the CDC surveillance data tracking the incidence rates of C auris. Contagion interviewed Lyman last year, and she explained the CDC stresses the importance of these medical facilities being proactive in their approach to infection prevention. “Implementing these practices effectively and ensuring there’s good compliances is important but not always easy. It takes a lot of work and investment of resources,” Lyman stated.⁴

References
1.Update on C auris – The Partners for Patients Safety Program Screening and Cases. Public Health Seattle and King County. Accessed February 2, 2024. https://publichealthinsider.com/2024/01/30/update-on-c-auris-the-partners-for-patient-safety-program-screening-and-cases/

2.Parkinson J. Tracking Candida Auris. ContagionLive. July 5, 2023. Accessed February 3, 2024. https://www.contagionlive.com/view/tracking-candida-auris

3. Benedict K, Forsberg K, Gold J, et al. Candida auris‒Associated Hospitalizations, United States, 2017–2022. Emerging Infectious Diseases. 2023;29(7):1485-1487. doi:10.3201/eid2907.230540

4. Parkinson J. Placing Context Around Public Health Messaging, Addressing Infection Prevention for Candida Auris. ContagionLive. March 30, 2023. Accessed February 3, 2024.