Poorly cleaned equipment causes first pediatric cluster of C. auris in US

Key takeaways:

• A cluster of Candida auris at a health care facility in Nevada last year was likely caused by poorly cleaned equipment used in the adult wings.
• The cluster involved three children.

SEATTLE — The first U.S. cluster of pediatric Candida auris cases was likely caused by shared mobile medical equipment that was not properly sanitized after being used for adult patients, an investigation found.

According to findings presented at the Society for Healthcare Epidemiology of America Spring Meeting, as of May 2022, 117 cases of C. auris were identified in 16 health care facilities in Nevada, including three pediatric cases.

Multiple studies have shown an increase in cases of the drug-resistant fungus since the start of the pandemic.

“This was the first cluster of pediatric patients at an acute-care hospital in the United States, which occurred at a facility with a high number of adult C. auris cases,” Sophie Jones, PhD, MSc, BSC, an Epidemic Intelligence Service Officer in the CDC’s Division of Healthcare Quality Promotion, told Healio.

“All three pediatric patients also had invasive bloodstream infection, which can be serious and associated with a high mortality rate,” Jones said. “Until this outbreak, pediatric cases of C. auris in the United States had been rare, so we investigated these cases specifically to learn what had contributed to these patients acquiring C. auris.”

Jones said the goal of the investigation, which involved reviewing medical charts, was to “improve our understanding of what the common links were between the adult and pediatric patients to understand how C. auris spread to the pediatric patients.”

“We also observed practices by health care professionals and environmental services personnel to see if we could identify opportunities for transmission of C. auris to the pediatric patients,” Jones said. “Specifically, we observed hand hygiene compliance, use of personal protective equipment and environmental cleaning and disinfection practice. Environmental sampling was also done from high-touch areas and mobile medical equipment to see if we could identify contaminated surfaces that might be contributing to C. auris transmission.”

All three pediatric patients included in the study were born at the unnamed facility with congenital heart defects, and all were aged younger than 6 months when they developed C. auris bloodstream infections. Investigators noted lapses in knowledge and practice for cleaning and disinfection of medical equipment shared between adult and pediatric units, and isolated C. auris from equipment used by adult patients, that was designated as clean.

Jones suggested that further studies document colonization patterns and trends, and that skin microbiome studies will be helpful to fill in some information gaps regarding duration of colonization.

She also cautioned that the outbreak “is an example of what is possible at other acute-care hospitals that serve both adult and pediatric patients.”

“While pediatric patients have largely been unaffected by C. auris in the United States previously, this outbreak demonstrates that they are also at risk,” Jones said. “Health care professionals need to remain vigilant for detecting cases of C. auris in pediatric patients, especially if there is evidence of transmission among adult patients at their facility. Facilities will need to take action in a timely manner if they detect cases and strengthen their infection prevention and control practices to minimize the risk of introduction to this population.”