Repeated Prevalence Surveys and Admission Screening for Candida auris at One Long-Term Acute-Care Hospital, Chicago, 2016–2019

Abstract

Background: Since the initial identification of Candida auris in 2016 in Chicago, ongoing spread has been documented in the Chicago area, primarily among older adults with complex medical issues admitted to high-acuity long-term care facilities, including long-term acute-care hospitals (LTACHs). As of October 2019, 790 cases have been reported in Illinois. Knowing C. auris colonization status on admission is important for prompt implementation of infection control precautions. We describe periodic facility point-prevalence surveys (PPSs) and admission screening at LTACH A. Methods: Beginning September 2016, we conducted repeated PPSs for C. auris colonization at LTACH A. After a baseline PPS, we initiated admission screening in May 2019 for patients without prior evidence of C. auris colonization or infection. C. auris screening specimens consisted of composite bilateral axillary/inguinal swabs tested at public health laboratories. We compared a limited set of patient characteristics based on admission screening results. Results: From September 2016 through October 2019, 277 unique patients were screened at LTACH A during 10 PPSs. Overall, 36 patients (13%) were identified to be colonized. The median facility C. auris prevalence increased from 2.8% in 2016 to 37% in 2019 (Fig. 1). During May–September 2019, among 174 unique patients admitted, 151 (87%) were screened for C. auris colonization on admission, of whom 18 (12%) were found to be colonized. Overall, 14 patients were known to have C. auris colonization on admission and were not rescreened, and 9 patients were discharged before screening specimens could be collected. A significantly higher proportion of patients testing positive for C. auris on admission had a central venous catheter or a peripherally inserted central catheter or were already on contact precautions (Table 1). The PPS conducted on October 1, 2019, revealed 5 new C. auris colonized patients who had screened negative on admission. Conclusions: Repeated PPSs at LTACH A indicated control of C. auris transmission in 2016–2017, followed by increasing prevalence beginning in May 2018, likely from patients admitted with unrecognized C. auris colonization and subsequent facility spread. Admission screening allowed for early detection of C. auris colonization. However, identification during subsequent PPS of additional colonized patients indicates that facility transmission is ongoing. Both admission screening and periodic PPSs are needed for timely detection of colonized patients. Given the high C. auris prevalence in LTACHs and challenges in identifying readily apparent differences between C. auris positive and negative patients on admission, we recommend that all patients being admitted to an LTACH in endemic areas should be screened for C. auris.

Funding: None

Disclosures: None