Survey reveals ‘important gaps’ in Canadian hospitals’ preparedness for C. auris
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A survey of hospitals participating in the Canadian Nosocomial Infection Surveillance Program demonstrates that these facilities are not adequately prepared for Candida auris, despite the fact that the first multidrug-resistant case of the illness was reported in the country in 2017, according to findings published in Infection Control & Hospital Epidemiology.
“As of Oct. 2019, five provinces had reported 24 cases with variable susceptibility,” the authors wrote. “To date, no program has been implemented for systematic surveillance of C. auris in Canada, and data to inform best practices in microbiology and infection prevention and control (IPAC) remain sparse.”
The Canadian Nosocomial Infection Surveillance Program, or CNISP, assembled a C. auris interest group in January 2018. Felipe Garcia-Jeldes, MD, of the CHU de Québec-Université Laval in Quebec, and colleagues surveyed hospitals participating in the CNISP to evaluate the facilities’ preparedness for C. auris.
The survey included five IPAC questions and 12 microbiology lab questions. Following pilot testing at three hospitals, the survey was sent via email to IPAC and microbiology leaders at all CNISP hospitals (n = 66), which are served by 32 microbiology labs. The surveys were completed by 85% of CNISP hospitals (n = 56) and 84% of CNISP laboratories (n = 27).
Of the 56 hospitals, 10 (18%) had a written policy stating which patients should be screened for C. auris colonization; an additional 11 hospitals (20%) suggested some patient screening was needed.
The most frequently recommended screening (18 of 21 hospitals; 86%) was for roommates of colonized or infected patients. Three hospitals (14%) recommended screening upon admission for patients who had recently received health care in the Indian subcontinent.
Of the laboratories surveyed, 23 (85%) reported that susceptibility testing was completed on some Candida isolates identified in their labs. When asked about their confidence that a clinically significant C. auris isolates would be correctly identified in their laboratory, 14 (52%) reported being confident that isolates from sterile sites and nonsterile site isolates resistant to at least one antifungal agent would be correctly identified.
Eight of the laboratories (30%) were confident that isolates from sterile sites could be identified but not from nonsterile sites, according to Garcia-Jeldes and colleagues, and one (4%) was confident that resistant isolates but not susceptible isolates from sterile sites could be correctly identified. Further, four labs (15%) were not confident in their ability to identify any incidences of C. auris. Only three laboratories (11%) reported having a standard operating procedure for handling screening swabs to detect C. auris colonization.
Although the structure of the survey may have resulted in “misinterpretation of opinion or loss of information,” the results reveal ”important gaps” in the ability of hospitals and laboratories to identify patients with C. auris.
“CNISP members agreed in 2018 to establish surveillance for C. auris, national infection prevention and control guidelines are in development, and some provinces have issued preliminary guidance and/or included C. auris in laboratory proficiency testing,” Garcia-Jeldes and colleagues wrote. “How effective these responses will be in protecting our patients from transmission of C. auris in Canadian hospitals remains to be seen.” - by Earl Holland Jr.
Disclosures: The authors report no relevant financial disclosures.
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