Major Article
First reported outbreak of the emerging pathogen Candida auris in Canada

https://doi.org/10.1016/j.ajic.2021.01.013Get rights and content

Highlights

  • Candida auris is associated with health-care associated infection in Canada.

  • Strict infection control practices can halt the progression of nosocomial transmission.

  • Routine chromogenic media can be used to detect Candida auris.

  • Whole-genome sequencing is helpful in establishing nosocomial transmission.

Background

Candida auris was first described in Japan in 2009 and has since been detected in over 40 countries. The yeast is concerning for multiple reasons, primarily: (1) challenges with accurate identification; (2) reported multidrug resistance; (3) published mortality rates of 30%-60%; and (4) persistence in the environment associated with human transmission. We report the emergence of a healthcare-associated cluster in the Greater Vancouver area in 2018 and describe the measures implemented to contain its transmission.

Methods

Cases were identified through passive and ring surveillance of affected wards. Positive isolates were sent to provincial and national reference laboratories for confirmation and genomic characterization. Extensive infection control measures were implemented immediately after the initial case was identified.

Results

Four cases were identified during the outbreak. In a 4-month period, over 700 swabs were collected in order to screen 180 contacts. Whole genome sequencing concluded that all isolates clustered together and belonged to the South Asian clade. No isolates harbored FKS gene mutations associated with resistance to echinocandins. Infection control measures, including surveillance, education, cleaning and/or disinfection, patient cohorting, isolation, and hand hygiene, effectively contained the outbreak; it was declared over within 2 months.

Conclusions

The spread of C auris in healthcare facilities has not spared Canadian institutions. Our experience demonstrates that strict infection control measures combined with microbiological screening can effectively halt transmission in healthcare centers. The necessity of active prospective screening remains unclear.

Section snippets

Outbreak report

The community hospital affected by the outbreak is a 218-bed facility with a 10 bed ICU, and is part of a regionalized health system with approximately 1,500 acute care beds. Infection prevention and control (IPAC) and diagnostic microbiology services are provided by centralized departments offering distributed services to the health authority. The community hospital has dedicated IPAC practitioners on site, whereas microbiological specimens are forwarded to a central laboratory for processing.

Microbiology & genomics

Yeast isolated from clinical specimens was presumptively identified as C auris using the Bruker Biotyper MALDI-TOF (6903 database). A verification had previously been performed to confirm the accuracy of the platform for detecting C auris.10 All isolates were forwarded to the provincial reference laboratory for confirmatory identification. At the time of the outbreak, there were no commercial selective media options available for screening of C auris. Screening swabs were planted to Brilliance

Discussion

We report the first outbreak of C auris in Canada, which occurred in the ICU of a community hospital in the Greater Vancouver area of British Columbia. Whole-genome sequencing conducted by our federal public health colleagues provided molecular epidemiological evidence linking the cases. It is unclear, however, as to how the C auris strain was introduced into the facility. One patient expired during the outbreak secondary to causes unrelated to C auris; the remaining patients were all

Conclusions

C auris is an emerging threat to healthcare institutions and has been responsible for a number of documented outbreaks. Our experience demonstrates that timely detection of the organism and rapid implementation of infection control measures are capable of limiting transmission; however, there are currently few guidelines to advise on strategies for effective admission screening protocols.17, 18, 19 The CDC recommends screening patients who have had an overnight stay in a healthcare facility

Acknowledgments

We would like to acknowledge the clinical staff, hospital administration, public health officials, and the IPAC team who were involved in direct care of the patients and management of the outbreak. We would also like to thank the staff of the microbiology laboratory for prompt and accurate identifications. Lastly, we would like to acknowledge the help of the colleagues we reached out to for advice and guidance based on their experiences with C auris.

References (20)

There are more references available in the full text version of this article.

Cited by (0)

Conflicts of interest: None to report.

Funding Source: No funding was obtained for the purposes of this outbreak investigation and manuscript preparation.

View full text