Environmental Contamination with Candida Species in Multiple Hospitals Including a Tertiary Care Hospital with a Candida auris Outbreak.

Jessica Ann Kumar,Jennifer L Cadnum,Chauna S Whitlow,Windy D Tanner,Curtis J Donskey,Nasia Safdar,Matthew H Samore,Jeanmarie Mayer,Brandon Eilertson,Sarah L Krein,Annette L Jencson

doi:10.20411/pai.v4i2.291

Abstract

Background:Environmental sources have been implicated as a potential source for exogenous acquisition of Candida species, particularly the emerging multidrug-resistant Candida auris. However, limited information is available on environmental reservoirs of Candida species in healthcare facilities.Methods:During a 6-month period, cultures for Candida species were collected from high-touch surfaces in patient rooms and from portable equipment in 6 US acute care hospitals in 4 states. Additional cultures were collected from sink drains and floors in one of the hospitals and from high-touch surfaces, portable equipment, and sink drains in a hospital experiencing an outbreak due to C. auris. Candida species were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectometry.Results:Candida species were recovered from patient rooms in 4 of the 6 hospitals. Seven of 147 patient room cultures (4.8%) and 1 of 57 (1.8%) portable equipment cultures were positive, with the most common species being C. parapsilosis. For the hospital where additional sites were sampled, Candida species were recovered from 8 of 22 (36.4%) hospital room floors and 4 of 17 (23.5%) sink drains. In the facility with a C. auris outbreak, Candida species were frequently recovered from sink drains (20.7%) and high-touch surfaces (15.4%), but recovery of C. auris was uncommon (3.8% of high-touch surfaces, 3.4% of sink drains, and 0% of portable equipment) and only present in rooms that currently or recently housed a patient with C. auris.Conclusion:Candida species often contaminate surfaces in hospitals and may be particularly common on floors and in sink drains. However, C. auris contamination was uncommon in a facility experiencing an outbreak, suggesting that current cleaning and disinfection practices can be effective in minimizing environmental contamination.

Highlights

Candida species are an important cause of invasive infections in healthcare settings, in immunocompromised and critically ill patients [1, 2]
C. auris contamination was uncommon in a facility experiencing an outbreak, suggesting that current cleaning and disinfection practices can be effective in minimizing environmental contamination
The ability of C. auris, C. parapsilosis, and Candida glabrata strains to survive for prolonged periods on dry and moist surfaces may increase the likelihood of transmission from the environment [17]

Summary

Introduction

Candida species are an important cause of invasive infections in healthcare settings, in immunocompromised and critically ill patients [1, 2]. Most infections due to Candida species are endogenous, exogenous acquisition may occur in healthcare facilities [1, 3,4,5,6,7,8,9,10,11,12,13,14]. Sanchez et al [4] demonstrated that a Candida parapsilosis strain causing infections was recovered from inanimate surfaces in a new intensive care unit before patients were admitted. The emerging fungal pathogen Candida auris has frequently been recovered from environmental surfaces in rooms of colonized or infected patients [13], and a recent report of an outbreak of C. auris in an intensive care unit linked transmission to shared temperature probes [14]. Limited information is available on environmental reservoirs of Candida species in healthcare facilities

Methods

Results

Discussion

Conclusion