August 15, 2019
The Virginia Department of Health (VDH) has been collaborating with the Maryland Department of Health regarding an ongoing Candida auris (C. auris) investigation. C. auris can cause invasive, life threatening infections and is an urgent public health concern due to its tendency to rapidly and easily spread in healthcare settings, its frequent resistance to antifungal agents, and because it can be difficult to identify using commonly available laboratory techniques.
A colonized case patient was recently identified in Virginia after receiving healthcare in Maryland. VDH has been working to identify all healthcare contacts of that case to ensure appropriate actions are taken, including lab testing of high-risk contacts to rule out C. auris colonization. It is possible that additional cases will be identified.
C. auris was first identified in 2009 in Japan. In the United States, 715 confirmed and probable clinical cases have been identified in 12 states as of May 31, 2019. The majority of C. auris cases have been detected in the New York City area, New Jersey, and the Chicago area (map and table). Two pan-resistant C. auris cases have been identified in the U.S. Early detection of C. auris is essential for containing its spread in healthcare facilities. We need your help to identify and prevent the spread of this emerging, drug-resistant pathogen.
What you can do to help:
- Educate yourself about C. auris. Importantly, be aware that patients can be colonized with C. auris, including on their skin and in their urine. Colonized patients do not have any signs or symptoms of infection, but can still pass the fungus to another person. Even after treatment for invasive infections, patients generally remain colonized with C. auris for long periods, and perhaps indefinitely.
- Be aware of risk factors for C. auris (e.g., international healthcare exposure, indwelling catheters, tracheostomies, multiple underlying medical conditions, immunocompromising conditions, and receipt of broad-spectrum antibiotics).
- Routinely ask all patients about recent travel and healthcare. Consider colonization screening for patients who have had an overnight stay in a healthcare facility outside the U.S. in the previous year, AND have infection or colonization with carbapenemase-producing Gram-negative bacteria. Public health resources are available for testing potentially exposed patients.
- C. auris was added to the Virginia Reportable Disease List in 2018. Notify your local health department immediately if you suspect or identify patients infected or colonized with C. auris.
- Talk to your microbiology lab and understand what methods they use to characterize yeast isolates. Work with your lab to ensure that yeast isolates, including those from non-sterile sites, are being completely characterized. Submit isolates as required to the state public health laboratory, the Division of Consolidated Laboratory Services, for yeast identification/confirmation (instructions and request form).
- Inter- and intra-facility communication is of the utmost importance to contain transmission of C. auris and other drug-resistant pathogens:
- Consistently and accurately, communicate with other healthcare facilities about patients’ colonization/infection status and isolation needs when patients are moved between facilities.
- Confirm that your microbiology and infection prevention departments communicate on a regular basis. If C. auris infection or colonization is identified, ensure the patients’ medical records are flagged accordingly, and patients and their families are notified and educated on their C. auris status (C. auris fact sheet).
- Work with your infection prevention and control colleagues to optimize basic infection prevention practices such as hand hygiene, proper use of personal protective equipment, and rapid identification and isolation of patients suspected to have multidrug-resistant organisms.
- The healthcare environment of C. auris cases should be disinfected using a registered sporicidal product from the Environmental Protection Agency’s List K.
- A Candida infection that is not responding to treatment suggests possible antifungal resistance. Consultation with an infectious disease specialist is highly recommended when caring for patients with C. auris infection. All C. auris isolates should undergo antifungal susceptibility testing; see treatment guidance.
Local and state health departments are taking the following steps:
- Working with microbiology laboratories where cases are located to establish enhanced surveillance techniques for prospective identification of additional cases from clinical cultures;
- Working with healthcare facilities where identified cases are located to ensure they are on contact precautions and that environmental cleaning practices are optimized to prevent transmission to other patients;
- Conducting colonization screening of potentially exposed healthcare contacts in partnership with the Centers for Disease Control and Prevention (CDC) and the Maryland Public Health Laboratory; and
- Working with public health agencies in surrounding jurisdictions to ensure a comprehensive regional response to prevent further spread of C. auris.
I appreciate your attention to this important matter. If you have any questions, please contact your local health department or the VDH Healthcare-Associated Infections/Antimicrobial Resistance Program at https://www.vdh.virginia.gov/surveillance-and-investigation/hai/contact-us/ or (804) 864-8141.
M. Norman Oliver, MD, MA
State Health Commissioner