Patients with recent ventilator, antibiotic use should be targeted for C. auris screening
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A study in New York showed that Candida auris colonization was associated with ventilator use, recent exposure to carbapenem antibiotics or fluconazole, and recent acute-care hospitalization.
Patients with these risk factors should be targeted for C. auris colonization screening, researchers said.
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“Investigations over the past few years have shown that many patients with Candida auris colonization and infection have resided on ventilator units in skilled nursing facilities or other high-acuity long-term care facilities,” Brendan R. Jackson, MD, an internal medicine specialist in the CDC’s Mycotic Diseases Branch, told Healio.
“Based on this background, the CDC assisted the New York State Department of Health in investigating cases of C. auris in these ventilator units to help protect this vulnerable population and reduce spread,” Jackson said. “Specifically, we were interested in identifying risk factors for C. auris colonization, since colonization conveys a risk for severe infection and can cause spread to other patients.”
Jackson and colleagues evaluated factors associated with C. auris colonization among ventilator-capable skilled nursing facility (vSNF) residents through a case-control investigation. According to the study, they abstracted data from medical records regarding facility transfers, antimicrobials and medical history.
Overall, 60 cases and 218 controls from six vSNFs were identified and included in the study. The study demonstrated that being on a ventilator (adjusted OR = 5.9; 95% CI, 2.3-15.4), receiving carbapenem antibiotics in the previous 90 days (aOR = 3.5; 95% CI, 1.6-7.6), having one or more acute-care hospital visit in the previous 6 months (aOR = 4.2; 95% CI, 1.9-9.6), and receiving systemic fluconazole in the previous 90 days (aOR = 6; 95% CI, 1.6-22.6) were associated with C. auris colonization.
The researchers deduced that targeted screening of patients in vSNFs with these risk factors could help identify colonized patients, leading to implementation of infection control measures.
“C. auris can spread readily in long-term care facilities, particularly in those that care for patients on ventilators, underscoring the importance of infection prevention and control, including robust hand hygiene, use of gowns and gloves, and proper environmental disinfection,” Jackson said. “Evidence from this investigation suggests that vSNF residents with indwelling devices are at greater risk of C. auris colonization than other residents, irrespective of age or comorbidities. These residents, as well as those with recent hospitalizations and broad-spectrum antibacterial and fluconazole use, can be monitored more closely for C. auris colonization.”
Jackson said detecting C. auris in a resident of a high-acuity skilled nursing facility unit means that “all residents should be considered at risk of acquiring C. auris and not just the residents’ roommates.”
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