Abstract
BackgroundCandida auris infections are an emerging global threat with poor clinical outcome, high mortality rate, high transmission rate and outbreak potential. The objective of this work is to describe a multidisciplinary approach towards the investigation and containment of a Candida auris outbreak and the preventive measures adopted in a resource limited setting.MethodsThis outbreak investigational study was conducted at a 1300-bedded tertiary care academic hospital in South India. The study included 15 adult inpatients with laboratory confirmed Candida auris isolates. The outbreak cluster was identified in adult patients admitted from September 2017 to 2019. The system response consisted of a critical alert system for laboratory confirmed Candida auris infection and multidisciplinary ‘Candida auris care team’ for patient management. The team implemented stringent Infection Prevention and Control (IPC) measures including patient cohorting, standardized therapy and decolonization, staff training, prospective surveillance and introduction of Candida auris specific care bundle.ResultsTwo outbreak clusters were identified; first cluster occurring between October and November 2017 and the second cluster in May 2018. The cohorts consisted of 7 and 8 Candida auris positive patients in the first and second waves of the outbreak respectively with a total survival rate of 93% (14/15). Deployment of containment measures led to gradual decline in the incidence of adult Candida auris positive cases and prevented further cluster formation.ConclusionsThe sustained implementation of guideline and evidence-based IPC measures and training of healthcare workers for improving awareness on systematically following standardized protocols of Candida auris related IPC practices successfully contained Candida auris outbreaks at our hospital. This demonstrates the feasibility of establishing a multidisciplinary model and bundling of practices for preventing Candida auris outbreaks in a Low- and Middle-income country.
Highlights
Candida auris infections are an emerging global threat with poor clinical outcome, high mortality rate, high transmission rate and outbreak potential
The sustained implementation of guideline and evidence-based Infection Prevention and Control (IPC) measures and training of healthcare workers for improving awareness on systematically following standardized protocols of Candida auris related IPC practices successfully contained Candida auris outbreaks at our hospital. This demonstrates the feasibility of establishing a multidisciplinary model and bundling of practices for preventing Candida auris outbreaks in a Lowand Middle-income country
Cost of care data associated with C. auris infection are scarce, though outbreak control costs were reported to be over £1 million and £58,000/month at an academic tertiary care setting in UK [10]
Summary
Candida auris infections are an emerging global threat with poor clinical outcome, high mortality rate, high transmission rate and outbreak potential. Candida species has been identified among 25% of Intensive Care Unit (ICU) patients with central line associated blood stream infections and the prevalence of C. auris was estimated to be ranging from 5 to 30% among Candidemia patients [2,3,4]. C. auris infections are associated with high mortality rate and poor outcomes attributed to high frequency of drug resistance and its tendency to affect immunocompromised patients. Cost of care data associated with C. auris infection are scarce, though outbreak control costs were reported to be over £1 million and £58,000/month at an academic tertiary care setting in UK [10]. The common biochemical methods such as analytical profile index strips or the prior version of VITEK 2, often misidentifies C. auris as other yeasts (most commonly Candida haemulonii, and Candida famata, Saccharomyces cerevisiae, and Rhodotorula glutinis) [12]
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