Surveillance provides real-time information about C. auris outbreak characteristics
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Active and passive Candida auris surveillance in southern California allowed researchers to identify cases and gain crucial data, including resistance information, in real time.
“As early as 2018, we were aware of the emergence of C. auris in southern California, there no data to know exactly which strain of C. auris was here and what characteristics it may have,” Shangxin Yang PhD, D(ABMM), assistant clinical professor and associate medical director of the clinical microbiology laboratory in the University of California, Los Angeles department of pathology and laboratory medicine, told Healio. “The lack of information about this deadly fungus was concerning.”
According to Yang, the UCLA Health System anticipated the impact C. auris and was proactively prepared before the outbreak having developed and validated an in-house C. auris PCR screening test by the summer of 2019. She added that the system also started screening high-risk patients in the fall which led to the successful identification of the first positive patient in October 2019.
“Since our lab has established a robust genomic surveillance program with the capability of real-time -generation sequencing of clinical isolates, we fully characterized our first isolate and found it to be the III, which originated from Africa and [is] rarely reported in the U.S.,” Yang said, adding that before 2019, the C. auris outbreaks in New York were predominately I which originated from South Asia and those in Chicago were predominately IV, which originated from South America. “It is quite unique here to have the III in .”
According to Yang, the COVID-19 pandemic slowed down the spread of C. auris in early 2020 but then intensified after the summer when patients started coming back into the hospitals.
“The lack of , patient isolation and cohorting due to COVID-19, more chronically ill patients due to COVID-19 sequelae and health care work shortage all contribute to the intensified spread of C. auris,” Yang said.
To assess all cases of C. auris reported in southern California between 2019 and 2022, Yang and colleagues performed active and passive surveillance to screen hospitalized patients. According to the study, C. auris PCR assay on inguinal-axillary swabs was performed on high-risk patients at admission. All identified C. auris isolates were then characterized by both phenotypic antifungal susceptibility tests and whole-genome sequencing.
In total, 45 patients with C. auris were identified between late 2019 and early 2022 all of which were resistant to fluconazole but susceptible to echinocandins. According to the study, most patients had a tracheostomy or were from a facility with a known outbreak, though they added that seven patients were identified through passive surveillance. The overall mortality was 18%. Additional data showed that invasive C. auris infections were identified in 13 patients (29%), (69%) of whom had bloodstream infections and were more likely to have a central line.
Genomic analysis showed there is just one dominant -III lineage circulating in Los Angeles, with very limited intrahost and interhost genetic diversity, based on these cases.
“We demonstrate that a robust C. auris surveillance program can be established with multidisciplinary efforts involving both the microbiology lab and the hospital epidemiology team,” Yang said. “Our study provided real-time critical information about the characteristics of the C. auris outbreak strain in southern California that can help guide effective treatment and prevention policies.”
Yang added that they will continue genomic surveillance to identify any new variant or clade of C. auris that may emerge in the future and will alter the medical and public health community of any findings.
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