Candida auris in the US Department of Veterans’ Affairs (VA)

Abstract

Background:Candida auris is an emerging pathogen with high mortality and challenges in detection. C. auris healthcare-associated infections are now being reported worldwide. Most isolates are resistant to fluconazole, and some show resistance to all 3 classes of antifungals. Herein, we describe C. auris surveillance in the VA. Methods: Cultures were identified using VA data sources for C. auris isolates and surveillance cultures (axilla and groin) performed January 1, 2010, through October 15, 2019. Chart reviews were performed for patients with C. auris, including isolate susceptibilities and antifungal treatment. Results: Overall, 6 C. auris isolates from 3 patients at 2 VA hospitals (located in the Midwest and Northeast) were identified. From a single patient, 3 urine isolates were identified June–July 2018, and they were susceptible to all antifungals tested (voriconazole, posaconazole, micafungin, itraconazole, flucytosine, caspofungin, anidulafungin, amphotericin B, and fluconazole). No antifungal treatment was received (presumed colonization). C. auris surveillance cultures for 32 additional patients at this facility between July 10, 2018, and July 19, 2018, were negative. From a second patient (admitted November 9, 2018), 2 C. auris blood isolates were identified at the same facility, first on February 3, 2019, and they were susceptible to all antifungals tested (same as above). The infection was deemed healthcare associated, and the patient received 2 weeks of micafungin. On October 11, 2019, C. auris was identified again (susceptibilities as above) and another course of micafungin was started. A third patient from a different VA hospital had a C. auris sputum isolate (September 5, 2018, susceptibilities not reported), which was not treated with antifungals. This patient with tracheostomy had a documented history of C. auris colonization from a non-VA long-term care facility. This VA facility screened 3 additional patients for “rule out C. auris” between July 2018 and March 2019,finalized as C. parapsilosis (1 blood and 1 wound isolate) and C. tropicalis (1 blood isolate). At 2 other VA facilities, 3 patients had C. auris surveillance cultures performed in 2019, which were negative. Additionally, at least 65 isolates of C. haemulonii, which can be difficult to distinguish from C. auris, have been identified from 51 unique individuals at 24 other VA facilities since 2010. Conclusions: Two VA facilities have identified cases of C. auris infection and colonization. Additional awareness is needed because C. auris can be difficult to identify using traditional biochemical methods and may be resistant to standard treatment. According to the CDC, screening of close healthcare contacts should be considered for patients with newly identified C. auris infection or colonization. Early and accurate diagnosis are important for improving outcomes and reducing transmission of this rapidly emerging pathogen.

Funding: None

Disclosures: None