S8.1b Is a search and destroy strategy still feasible for Candida auris in South Africa?

Abstract

S8.1 Tackling Candida auris in resource-limited settings, September 23, 2022, 3:00 PM - 4:30 PM Candida auris was prospectively detected as a healthcare-associated pathogen in South Africa in 2014. However, a retrospective review of a culture collection from national laboratory-based surveillance for Candidaemia in 2009-10 showed that earlier cases had been missed owing to species misidentification. National surveillance, which was repeated during 2016-17, revealed that C. auris caused >10% of cases of Candidaemia in South Africa, with most (86%) cases detected in the Gauteng Province. We recommended all hospitals to passively monitor cases of C. auris disease and colonization by each maintaining a line list of culture-confirmed cases. Facilities were thus classified into three tiers. Tier 1 (‘green status’) included facilities with no prior known cases. Such facilities were requested to report their first cases for urgent intervention. This included active colonization surveys, isolation and/or cohorts of infected or colonized patients as well as intensified infection prevention and control and antifungal stewardship activities. Tier 2 (‘orange status’) included facilities with sporadic cases defined arbitrarily as fewer than 12 cases in the past 6 months and/or fewer than three units affected. Such facilities were requested to report any increase in the number of cases compared with a baseline, clinical units affected for the first time, or apparent case clustering within the facility for investigation. Tier 3 (‘red status’) included facilities with a relative endemicity defined as >12 cases and/or >3 units with cases in the last 6 months. Tier 3 facilities were only requested to report increases over a baseline or apparent clustering within the facility. Owing to limited resources, colonization screening of newly-admitted patients was not recommended in acute-care facilities in South Africa. During 2019-21, the proportion attributable to C. auris increased even further to 25% (of 12 959 national cases of Candidaemia), with a concomitant reduction in cases caused by C. parapsilosis. This suggested a concerning replacement of multidrug-resistant C. auris in an ecological healthcare niche previously occupied by azole-resistant C. parapsilosis. An epidemiological shift was also observed with an expanding number of acute healthcare facilities outside Gauteng Province reporting C. auris and large persistent healthcare-associated infection outbreaks in neonatal units, particularly in the under-resourced public health sector.