In-house PCR testing for C. auris on admission leads to fewer hospital-onset cases
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Key takeaways:
- Performing in-house PCR screening for C. auris revealed more cases on admission and fewer hospital-onset cases.
- In-house testing was cost-effective, saving between $700,000 and more than $3 million.
In-house PCR testing on admission for detection of Candida auris enabled researchers to identify more cases on admission and lowered rates of hospital-onset C. auris, a study showed.
“After the onset of the pandemic we started seeing more patients admitted with C. auris infection/colonization and risk factors for colonization/infection,” Rossana Rosa, MD, MSc, associate medical director for infection prevention and antimicrobial stewardship in the department of infection prevention of the Jackson Health System in Florida, told Healio.
“This presented a problem for us with regards to placement, since it’s recommended for patients suspected to have C. auris to be on private rooms, which were scarce amidst all the patients with COVID,” she said.
Because of this, Rosa said a strategy is needed to rapidly identify who was colonized with C. auris and should remain on special precautions, and who was not colonized.
To assess the impact of in-house PCR testing for C. auris colonization at patient admission, Rosa and colleagues tested patients in the health system based on risk factors for C. auris carriage and processed PCR tests in-house rather than send them to a reference lab.
The researchers then assessed changes in the incidence rates of C. auris present on admission (CA-POA) and C. auris hospital-onset fungemia (CA-HOF) using interrupted time series analysis, as well as the economic impact on isolation and testing costs.
A total of 4,478 colonization screening PCRs belonging to 4,270 patients were performed during the study period. From these, the team identified 159 unique cases of CA-POA and found that the IR of CA-POA increased in the post-intervention period (IRR = 2.57; 95% CI, 1.16-5.69) compared with the pre-intervention period (1.94 cases per 10,000 patient-admissions).
The researchers also identified 75 unique cases of CA-HOF. They observed a monthly decrease in IR of CA-HOF in the post-intervention period of 13% (95% CI, 0.8-0.99), whereas CA-HOF was increasing monthly by 14% (95% CI, 1.05-1.24) pre-intervention.
Additionally, the study showed that patients screened for C. auris had a median length of stay of 8 days and remained on contact precautions until C. auris PCR results were available.
Following the intervention — when PCR was performed in-house — the turnaround time from admission to report was 2 days vs. 11 days pre-intervention. Post-intervention, the total of estimated isolation and testing cost savings ranged from $772,513.10 to $3,730,480.26.
Doctors at other health care facilities have faced similar situations during the pandemic, including those at Cedars Sinai Medical Center in Los Angeles, who developed a PCR test in the hospital's microbiology lab to improve their C. auris surveillance.
“To respond to the growing threat of C. auris and other MDRs, we need to deploy rapid diagnostic technologies and doing so requires a multidisciplinary collaboration across different stakeholders,” Rosa said. “This project was the result of a joint effort between infection preventionists, microbiology laboratory, nursing and information technology teams.”
She concluded, “Get all your teams together, because it takes a village to fight C. auris.”
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