2039. New York State 2016–2018: Progression from Candida auris Colonization to Bloodstream Infection

Abstract

BackgroundNew York State (NYS) is experiencing a continuing outbreak of Candida auris, first identified in 2016. Patients who are colonized asymptomatically with C. auris can progress to bloodstream infection (BSI).MethodsColonized patients with positive nares or axilla/groin C. auris cultures were followed prospectively. Laboratories, hospitals and skilled nursing facilities reported C. auris clinical infections to the NYS Department of Health. Patient demographics, clinical history, hospital admission, procedures, and outcomes data were obtained using a standardized case report form. Patient-days were determined from date of first positive colonization to date of first positive clinical isolate, death, or March 30, 2018, whichever was first.ResultsBetween September 28, 2016 and March 30, 2018, 187 C. auris colonized patients were identified. Of these, seven progressed to BSI during at least 24,781 patient days of follow-up (median: 98 patient-days, range 0–548 days.) The median time from date of first colonization to date of BSI was 86 days (range 3–310 days). The median patient age at time of colonization was 71 years (range 57–89 years). Between colonization and BSI, patients had a median of five admissions in healthcare facilities (range 1–12). All patients had central neurologic disease, gastrostomy tubes, chronic wounds, and vascular lines at time of BSI. All patients had a positive culture for one or more other multi-drug resistant organism within 90 days of a positive C. auris culture, and all received antibiotics in the 30 days before BSI. Six (86%) patients received mechanical ventilation and had tracheostomies. Five (71%) patients had diabetes. Four (57%) had vascular lines replaced in the 30 days before BSI onset. Two (29%) cases had gastrostomy tube replacement between colonization and BSI. One patient died a week after C. auris BSI; a second died 4 months later.ConclusionIn NYS, 4% of C. auris colonized patients developed BSI, a rate of 0.3 BSI per 1,000 patient-days. BSI patients have portals of entry such as indwelling medical devices and wounds. Neurologic disease and diabetes may be risk factors for BSI. Meticulous aseptic technique for invasive procedures, device and wound care may help prevent C. auris BSI in colonized patients.Disclosures All authors: No reported disclosures.