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December 20, 2022

Candida auris – Increased transmission in U.S. healthcare facilities

Actions requested

  • Be aware that an emerging, often multidrug-resistant fungal pathogen, Candida auris (C. auris), is spreading westward across the U.S. and causing outbreaks in healthcare facilities.
    • As of December 2022, no C. auris cases have been reported in Washington State, but healthcare transmission has occurred in California, Oregon1,2, Nevada3, the Mid-West, and East Coast.
  • Inquire about high-risk exposures in all newly admitted patients and consider C. auris screening in patients at high risk for C. auris, including those who have had:
  • Immediately report any suspected or confirmed C. auris cases or outbreaks to Public Health by calling 206-296-4774.
    • C. auris becomes a notifiable condition in WA as of January 1, 2023.
  • Consultation with an infectious disease specialist and Public Health is highly recommended when C. auris colonization or infection is suspected to ensure appropriate testing and treatment.
  • Coordinate C. auris screening and testing with Public Health by calling 206-296-4774.
  • Be aware that C. auris can be misidentified through commercial laboratory testing and specific technology is needed for correct identification.
  • Be aware that in addition to the screening recommendations above, Public Health will soon begin offering proactive C. auris screening to residents at a local long-term ventilator capable healthcare facility. These are the types of settings which have been most heavily impacted in California and East Coast outbreaks.
  • Ensure appropriate infection prevention and control practices:

References

1 Oregon Health Authority News Release. OHA investigating state’s first cases of Candida auris infection. Dec 28, 2021.

2 Oregon Health Authority News Release. No other cases of Candida auris infection found at Salem Hospital. Jan 6, 2022.

3 Causey K. Candida auris technical bulletin April 22, 2022.

Background

Since its discovery in 2009, C. auris has emerged globally as a life-threatening, highly transmissible, often multidrug-resistant yeast. In the past year, CDC has published several reports of ongoing transmission of highly resistant strains of C. auris in United States’ healthcare facilities, particularly in units caring for patients recovering from COVID-194,5,6. Patients with long-term acute care and indwelling devices are at highest risk for acquisition. International healthcare is often the initial source of introduction of C. auris to a region. Subsequent healthcare transmission may occur due to shedding in the healthcare environment, resistance of C. auris to standard healthcare disinfectants, and lapses in infection control practices.

As of December 20, 2022, C. auris has not been detected in Washington but represents a serious threat to vulnerable patients. This map has details about where cases have been identified within the U.S. WA DOH performs special surveillance for C. auris by screening isolates submitted from high risk patients and sentinel lab submissions of non-albicans Candida species to the WA Public Health Laboratory for species identification.

References

4 Prestel C, Anderson E, Forsberg K, et al. Candida auris Outbreak in a COVID-19 Specialty Care Unit — Florida, July–August 2020. MMWR Morb Mortal Wkly Rep 2021;70:56–57. DOI

5 Lyman M, Forsberg K, Reuben J, et al. Notes from the Field: Transmission of Pan-Resistant and Echinocandin-Resistant Candida auris in Health Care Facilities ― Texas and the District of Columbia, January–April 2021. MMWR Morb Mortal Wkly Rep 2021;70:1022–1023. DOI.

6 Adams E, Quinn M, Tsay S, et al. Candida auris in Healthcare Facilities, New York, USA, 2013-2017. Emerg Infect Dis. 2018;24(10):1816-1824. DOI.

Resources

This health advisory is also available in PDF format

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