Background
What is Candida auris?
Candida auris (C. auris) is a type of yeast, first described in 2009, causing a serious global threat due to the increasing occurrence of patients infected or colonized with this difficult to treat and difficult to control organism.
Why should I be concerned about C. auris?
- C. auris can easily be transmitted from person-to-person and can persist on surfaces in healthcare settings.
- C. auris can be misidentified when using traditional yeast identification methods.
- C. auris isolates are often multi-drug resistant, limiting available treatment options.
What is VDH doing to slow the spread of C. auris?
In Virginia, a systematic public health response and investigation occurs upon identification of every C. auris case. VDH follows the CDC Containment Strategy Guidelines for Novel or Targeted Multidrug-Resistant Organisms.
Infection Prevention
Infection prevention is an important strategy to stop the transmission of C. auris. This involves transmission-based precautions, choosing the right environmental cleaning product, and monitoring staff compliance with infection prevention practices. See the below resources for more information.
VDH Candida auris Education Booklet for Healthcare Facilities (10/2023)
VDH Prevention of Candida auris in Acute Care and Long-Term Acute Care Facilities (04/28/2023)
VDH Prevention of Candida auris in Long-Term Care Facilities (04/28/2023)
VDH Quick Guide for Nursing Home Infection Preventionists: C. auris (09/07/2023)
Public Health Response: Virginia Containment Strategy for Candida auris
A coordinated approach between healthcare facilities and local health departments is necessary to slow the spread. The public health response involves:
- Promptly detecting the presence of C. auris in specimens;
- Collecting the least amount of information needed to determine appropriate recommendations based on CDC Containment Strategy Guidance;
- Verifying appropriate infection control measures (e.g., contact precautions, private room) are implemented by the healthcare facility to stop transmission, and performing onsite assessments of infection prevention practices;
- Identifying affected patients, determining whether transmission to other patients is occurring or has occurred, and recommending appropriate infection control measures to stop further transmission;
- Facilitating colonization screenings of high-risk healthcare contacts so that additional infection prevention measures can be put into place; and
- Continuing to work with the facility or setting on enhanced surveillance and implementation of infection prevention practices.
Learn more about the Virginia Containment Strategy for Candida auris
Reporting Requirements
The State Board of Health updated the Virginia Regulations for Disease Reporting and Control (12 VAC 5-90-80) effective November 14, 2018. C. auris was added to the reportable disease list and conditions reportable by directors of laboratories. Thus, the responsibility for reporting the presence of these organisms rests with physicians, directors of medical care facilities, and directors of laboratories.
Report suspected or confirmed C. auris, infection or colonization, to your local health department.
- Submit a laboratory report and/or Epi-1 form.
- Include available antifungal susceptibility testing (AFST) results.
Submit any of the following isolates to DCLS using the DCLS Clinical Microbiology/Virology Request Form and including AFST results with submission:
- All confirmed C. auris and Candida haemulonii isolates from any specimen source.
OR - Yeast isolates from any specimen source when unable to identify species after identification is attempted per laboratory policies.
OR - Suspected C. auris isolates from any specimen source. C. auris can be misidentified if your laboratory uses certain yeast identification methods. Isolates identified based on Table 1 should be sent to DCLS for confirmation.
Table 1. Virginia Isolate Submission Requirements for Suspect or Confirmed C. auris and C. haemulonii by Identification Method
| Identification Method, Database/Software (if applicable) | Can Identify C. auris | Isolates Required to Send to DCLS^ |
|---|---|---|
| Bruker Biotyper MALDI-TOF, RUO libraries (Versions 2014 [5627] and more recent) | Yes | C. auris C. haemulonii |
| Bruker Biotyper MALDI-TOF, CA System library (Version Claim 4) | Yes | C. auris C. haemulonii |
| bioMérieux VITEK MS MALDI-TOF, RUO library (with Saramis Version 4.14 database and Saccharomycetaceae update) | Yes | C. auris C. haemulonii |
| bioMérieux VITEK MS MALDI-TOF, IVD library (v3.2) | Yes | C. auris C. haemulonii |
| bioMérieux VITEK MS MALDI-TOF, Older IVD libraries | No | C. haemulonii C. lusitaniae |
| Vitek 2 YST, Software version 8.01 | Yes | C. auris C. duobushaemulonii C. haemulonii |
| Vitek 2 YST, Older versions | No | C. duobushaemulonii C. haemulonii |
| API20C | No | C. haemulonii C. sake Rhodotorula glutinis (characteristic red color not present) |
| BD Phoenix | No | C. catenulate C. haemulonii |
| MicroScan | No | C. famata, C. guilliermondii, C. haemulonii, C. lusitaniae, C. parapsilosis |
| RapID Yeast Plus | No | C. haemulonii C. parapsilosis |
| GenMark ePlex BCID-FP Panel | C. auris C. haemulonii |
^In addition to isolates listed, also send any yeast isolates from any specimen source when unable to identify species after identification is attempted per laboratory policies, regardless of identification method.
Public Health Laboratory Testing and Response
- Identify C. auris isolates.
- Identify early, high-priority results that would require immediate notification to Centers for Disease Control and Prevention (CDC), and be potentially characterized further at the regional antibiotic resistance laboratory or CDC.
- Facilitate submission of isolates with high-priority results to the regional antibiotic resistance laboratory or CDC for additional testing.
- Confirm species identification by MALDI-TOF (Bruker Biotyper)
- Other public health testing may occur as needed and will be facilitated through the CDC Antimicrobial Resistance Laboratory Network
- Pure yeast isolates should be submitted on a Sabouraud Dextrose agar slant or other appropriate media suitable for the growth of yeast. Ship isolates at room temperature.
- Submit a completed DCLS Clinical Microbiology/Virology Request Form and AFST results for each isolate.
- VDH and the submitter will be contacted when C. auris is identified.
Contact the HAI/AR Program for questions or discussion.
Last Reviewed: December 2018. VDH will review this interpretive guidance annually at a minimum, and as needed due to regulation changes.
Impact in Virginia
Cases in Virginia
- C. auris May 2023 Report
- C. auris April 2023 Report
- C. auris March 2023 Report
- C. auris February 2023 Report
- C. auris December 2022 Report
- C. auris November 2022 Report
- C. auris October 2022 Report
- C. auris September 2022 Report
Cases in the United States
Most C. auris cases in the United States have been detected in the New York City area, New Jersey, and the Chicago area. Strains of C. auris in the United States have been linked to other parts of the world. The CDC updates C. auris case counts by state on a monthly basis.
Emergency Department Care Coordination System
The Emergency Department Care Coordination (EDCC) Program was established in 2017 to provide a statewide technology solution that connects healthcare facilities, including acute care hospitals and post-acute care facilities. EDCC now includes MDRO flags for Candida auris and Carbapenemase-producing Organisms (CPOs), but facilities should still communicate MDRO status on transfer as the alerts are not real-time and only include information for Virginia patients and residents known to VDH. The flags are not intended to replace recommended communication, but to provide an additional layer of information.
Resources
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