Is routine screening for Candida auris necessary in ICU?
,
Abstract
Background and Objectives: The capability to cause invasive infection, multi-drug resistance, and health care-associated outbreaks of Candida auris have made it a pathogen of great concern. Estimating how many patients in our intensive care unit had C. auris colonization and what characteristics put patients at risk for having Candida spp. colonization were the primary goals of the study.
Materials and Methods: Swabs from axilla and groin were collected from 229 patients getting admitted to the ICU. Samples were inoculated into CHROMagarTMCandida Plus medium. Colonies presumptively identified as C. auris by the presence of light blue with blue halo and were confirmed by VITEK-2.
Results: Our study showed that only one patient was colonized with C. auris. A total of 47 (20.5%) patients were colonized with Candida spp., of which Candida parapislosis was the predominant organism. History of antibiotic use and cerebrovascular accident were independent risk factors in Candida colonization.
Conclusion: Active screening for Candida auris in all patients is not required in our hospital as the prevalence was very low and not cost-effective. Therefore we plan to modify our screening strategy and use risk factors based surveillance strategy as it may serve as an ideal strategy.
1. Jeffery-Smith A, Taori SK, Schelenz S, Jeffery K, Johnson EM, Borman A, et al. Candida auris: a review of the literature. Clin Microbiol Rev 2017; 31(1): e00029-17.
2. Tsay S, Welsh RM, Adams EH, Chow NA, Gade L, Berkow EL, et al. Notes from the field: ongoing transmission of Candida auris in health care facilities-United States, June 2016–May 2017. MMWR Morb Mortal Wkly Rep 2017; 66: 514-515.
3. Vallabhaneni S, Kallen A, Tsay S, Chow N, Welsh R, Kerins J, et al. Investigation of the first seven reported cases of Candida auris, a globally emerging invasive, multidrug-resistant fungus-United States, May 2013-August 2016. Am J Transplant 2017; 17: 296-299.
4. Harris E. CDC: Candida auris fungal infections and drug resistance on the rise. JAMA 2023; 329: 1248.
5. Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol 2009; 53: 41-44.
6. Lee WG, Shin JH, Uh Y, Kang MG, Kim SH, Park KH, et al. First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol 2011; 49: 3139-3142.
7. Lockhart SR, Etienne KA, Vallabhaneni S, Farooqi J, Chowdhary A, Govender NP, et al. Simultaneous emergence of multidrug-resistant Candida auris on 3 continents confirmed by whole-genome sequencing and epidemiological analyses. Clin Infect Dis 2017; 64: 134-140.
8. Schelenz S, Hagen F, Rhodes JL, Abdolrasouli A, Chowdhary A, Hall A, et al. First hospital outbreak of the globally emerging Candida auris in a European hospital. Antimicrob Resist Infect Control 2016; 5: 35.
9. Egger NB, Kainz K, Schulze A, Bauer MA, Madeo F, Carmona-Gutierrez D. The rise of Candida auris: from unique traits to co-infection potential. Microb Cell 2022; 9: 141-144.
10. Vallabhaneni S, Kallen A, Tsay S, Chow N, Welsh R, Kerins J, et al. Investigation of the first seven reported cases of Candida auris, a globally emerging invasive, multidrug-resistant fungus-United States, May 2013-August 2016. MMWR Morb Mortal Wkly Rep 2016; 65: 1234-1237.
11. Santana DJ, Anku JAE, Zhao G, Zarnowski R, Johnson CJ, Hautau H, et al. A Candida auris-specific adhesin, Scf1, governs surface association, colonization, and virulence. Science 2023; 381: 1461-1467.
12. Yune PS, Coe J, Rao M, Lin MY. Candida auris in skilled nursing facilities. Ther Adv Infect Dis 2023; 10: 20499361231189958.
13. Eyre DW, Sheppard AE, Madder H, Moir I, Moroney R, Quan TP, et al. A Candida auris outbreak and its control in an intensive care setting. N Engl J Med 2018; 379: 1322-1331.
14. Jones CR, Neill C, Borman AM, Budd EL, Cummins M, Fry C, et al. The laboratory investigation, management, and infection prevention and control of Candida auris: a narrative review to inform the 2024 national guidance update in England. J Med Microbiol 2024; 73: 001820.
15. Zhu Y, O'Brien B, Leach L, Clarke A, Bates M, Adams E, et al. Laboratory analysis of an outbreak of Candida auris in New York from 2016 to 2018: impact and lessons learned. J Clin Microbiol 2020; 58(4): e01503-19.
16. Cadnum JL, Shaikh AA, Piedrahita CT, Sankar T, Jencson AL, Larkin EL, et al. Effectiveness of disinfectants against Candida auris and other candida species. Infect Control Hosp Epidemiol 2017; 38: 1240-1243.
17. Parente DM, Cunha CB, Mylonakis E, Timbrook TT. The clinical utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA Pneumonia: A Diagnostic Meta-analysis with antimicrobial stewardship implications. Clin Infect Dis 2018; 67: 1-7.
18. Decraene V, Phan HTT, George R, Wyllie DH, Akinremi O, Aiken Z, et al. A large, refractory nosocomial outbreak of Klebsiella pneumoniae Carbapenemase-Producing Escherichia coli demonstrates carbapenemase gene outbreaks Involving sink sites require novel approaches to infection control. Antimicrob Agents Chemother 2018; 62(12): e01689-18.
19. Greco C, Smith H, Gilbert B, Martin J, Smyer J, Haden M, et al. Candida auris inpatient screening in collaboration with the public health department. Am J Infect Control 2024; 52: 981-983.
20. Mizusawa M, Miller H, Green R, Lee R, Durante M, Perkins R, et al. Can multidrug-resistant Candida auris be reliably identified in clinical microbiology laboratories? J Clin Microbiol 2017; 55: 638-640.
21. Sharp A, Borman AM, Perera N, Randle M, Braham S, Taori S, et al. Assessing routine diagnostic methods for detecting Candida auris in England. J Infect 2018; 77: 448-454.
22. Prakash A, Sharma C, Singh A, Kumar Singh P, Kumar A, Hagen F, et al. Evidence of genotypic diversity among Candida auris isolates by multilocus sequence typing, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and amplified fragment length polymorphism. Clin Microbiol Infect 2016; 22: 277. e1-9.
23. Kathuria S, Singh PK, Sharma C, Prakash A, Masih A, Kumar A, et al. Multidrug-resistant Candida auris misidentified as Candida haemulonii: characterization by matrix-assisted laser desorption ionization-time of flight mass spectrometry and DNA sequencing and its antifungal susceptibility profile variability by Vitek 2, CLSI broth microdilution,and Etest method. J Clin Microbiol 2015; 53: 1823-1830.
24. Ahmad S, Alfouzan W. Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal susceptibility, and infection control measures to combat the spread of infections in healthcare Facilities. Microorganisms 2021; 9: 807.
25. Perry JD. A decade of development of chromogenic culture media for clinical microbiology in an era of molecular diagnostics. Clin Microbiol Rev 2017; 30: 449-479.
26. Scharmann U, Kirchhoff L, Chapot VLS, Dziobaka J, Verhasselt HL, Stauf R, et al. Comparison of four commercially available chromogenic media to identify Candida albicans and other medically relevant Candida species. Mycoses 2020; 63: 823-831.
27. Willinger B, Hillowoth C, Selitsc B, Manafi M. Performance of Candida ID, a new chromogenic medium for presumptive identification of Candida species, in comparison to CHROMagar Candida. J Clin Microbiol 2001; 39: 3793-3795.
28. Sharma U, Patel K, Shah V, Sinha S, Rathore VPS. Isolation and speciation of Candida in Type II diabetic patients using CHROM Agar: a microbial study. J Clin Diagn Res 2017; 11: DC09-DC11.
29. Sharp A, Muller-Pebody B, Charlett A, Patel B, Gorton R, Lambourne J, et al. Screening for Candida auris in patients admitted to eight intensive care units in England, 2017 to 2018. Euro Surveill 2021; 26: 1900730.
30. Rudramurthy SM, Chakrabarti A, Paul RA, Sood P, Kaur H, Capoor MR, et al. Candida auris candidaemia in Indian ICUs: analysis of risk factors. J Antimicrob Chemother 2017; 72: 1794-1801.
31. Chakrabarti A, Sood P, Rudramurthy SM, Chen S, Kaur H, Capoor M, et al. Incidence, characteristics and outcome of ICU-acquired candidemia in India. Intensive Care Med 2015; 41: 285-295.
32. Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill 2018; 23: 1800516.
33.Rowlands J, Dufort E, Chaturvedi S, Zhu Y, Quinn M, Bucher C, et al. Candida auris admission screening pilot in select units of New York city health care facilities, 2017-2019. Am J Infect Control 2023; 51: 866-870.
34. Zarei Mahmoudabadi A, Rezaei-Matehkolaei A, Navid M, Torabizadeh M, Mazdarani S. Colonization and antifungals susceptibility patterns of Candida species isolated from hospitalized patients in ICUs and NICUs. J Nephropathol 2015; 4: 77-84.
35. Yang YL, Leaw SN, Wang AH, Chen HT, Cheng WT, Lo HJ. Characterization of yeasts colonizing in healthy individuals. Med Mycol 2011; 49: 103-106.
36. Schulte DM, Sethi A, Gangnon R, Duster M, Maki DG, Safdar N. Risk factors for Candida colonization and Co-colonization with multi-drug resistant organisms at admission. Antimicrob Resist Infect Control 2015; 4: 46.
37. Mulet Bayona JV, Salvador García C, Tormo Palop N, Gimeno Cardona C. Evaluation of a novel chromogenic medium for Candida spp. identification and comparison with CHROMagar™ Candida for the detection of Candida auris in surveillance samples. Diagn Microbiol Infect Dis 2020; 98: 115168.
38. de Jong AW, Dieleman C, Carbia M, Mohd Tap R, Hagen F. Performance of two novel chromogenic Media for the identification of multidrug-resistant Candida auris compared with other commercially available formulations. J Clin Microbiol 2021; 59(4): e03220-20.
39. Kumar A, Sachu A, Mohan K, Vinod V, Dinesh K, Karim S. Simple low cost differentiation of Candida auris from Candida haemulonii complex using CHROMagar Candida medium supplemented with Pal's medium. Rev Iberoam Micol 2017; 34: 109-111.
40. Ruiz-Gaitán A, Sigona-Giangreco I, Pérez-Royo JM, Garcia-Bustos V, García-Hita M, Valentín-Gómez E, et al. Usefulness of chromogenic media with fluconazole supplementation for presumptive identification of Candida auris. Diagnostics (Basel) 2023; 13: 231.
2. Tsay S, Welsh RM, Adams EH, Chow NA, Gade L, Berkow EL, et al. Notes from the field: ongoing transmission of Candida auris in health care facilities-United States, June 2016–May 2017. MMWR Morb Mortal Wkly Rep 2017; 66: 514-515.
3. Vallabhaneni S, Kallen A, Tsay S, Chow N, Welsh R, Kerins J, et al. Investigation of the first seven reported cases of Candida auris, a globally emerging invasive, multidrug-resistant fungus-United States, May 2013-August 2016. Am J Transplant 2017; 17: 296-299.
4. Harris E. CDC: Candida auris fungal infections and drug resistance on the rise. JAMA 2023; 329: 1248.
5. Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol 2009; 53: 41-44.
6. Lee WG, Shin JH, Uh Y, Kang MG, Kim SH, Park KH, et al. First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol 2011; 49: 3139-3142.
7. Lockhart SR, Etienne KA, Vallabhaneni S, Farooqi J, Chowdhary A, Govender NP, et al. Simultaneous emergence of multidrug-resistant Candida auris on 3 continents confirmed by whole-genome sequencing and epidemiological analyses. Clin Infect Dis 2017; 64: 134-140.
8. Schelenz S, Hagen F, Rhodes JL, Abdolrasouli A, Chowdhary A, Hall A, et al. First hospital outbreak of the globally emerging Candida auris in a European hospital. Antimicrob Resist Infect Control 2016; 5: 35.
9. Egger NB, Kainz K, Schulze A, Bauer MA, Madeo F, Carmona-Gutierrez D. The rise of Candida auris: from unique traits to co-infection potential. Microb Cell 2022; 9: 141-144.
10. Vallabhaneni S, Kallen A, Tsay S, Chow N, Welsh R, Kerins J, et al. Investigation of the first seven reported cases of Candida auris, a globally emerging invasive, multidrug-resistant fungus-United States, May 2013-August 2016. MMWR Morb Mortal Wkly Rep 2016; 65: 1234-1237.
11. Santana DJ, Anku JAE, Zhao G, Zarnowski R, Johnson CJ, Hautau H, et al. A Candida auris-specific adhesin, Scf1, governs surface association, colonization, and virulence. Science 2023; 381: 1461-1467.
12. Yune PS, Coe J, Rao M, Lin MY. Candida auris in skilled nursing facilities. Ther Adv Infect Dis 2023; 10: 20499361231189958.
13. Eyre DW, Sheppard AE, Madder H, Moir I, Moroney R, Quan TP, et al. A Candida auris outbreak and its control in an intensive care setting. N Engl J Med 2018; 379: 1322-1331.
14. Jones CR, Neill C, Borman AM, Budd EL, Cummins M, Fry C, et al. The laboratory investigation, management, and infection prevention and control of Candida auris: a narrative review to inform the 2024 national guidance update in England. J Med Microbiol 2024; 73: 001820.
15. Zhu Y, O'Brien B, Leach L, Clarke A, Bates M, Adams E, et al. Laboratory analysis of an outbreak of Candida auris in New York from 2016 to 2018: impact and lessons learned. J Clin Microbiol 2020; 58(4): e01503-19.
16. Cadnum JL, Shaikh AA, Piedrahita CT, Sankar T, Jencson AL, Larkin EL, et al. Effectiveness of disinfectants against Candida auris and other candida species. Infect Control Hosp Epidemiol 2017; 38: 1240-1243.
17. Parente DM, Cunha CB, Mylonakis E, Timbrook TT. The clinical utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA Pneumonia: A Diagnostic Meta-analysis with antimicrobial stewardship implications. Clin Infect Dis 2018; 67: 1-7.
18. Decraene V, Phan HTT, George R, Wyllie DH, Akinremi O, Aiken Z, et al. A large, refractory nosocomial outbreak of Klebsiella pneumoniae Carbapenemase-Producing Escherichia coli demonstrates carbapenemase gene outbreaks Involving sink sites require novel approaches to infection control. Antimicrob Agents Chemother 2018; 62(12): e01689-18.
19. Greco C, Smith H, Gilbert B, Martin J, Smyer J, Haden M, et al. Candida auris inpatient screening in collaboration with the public health department. Am J Infect Control 2024; 52: 981-983.
20. Mizusawa M, Miller H, Green R, Lee R, Durante M, Perkins R, et al. Can multidrug-resistant Candida auris be reliably identified in clinical microbiology laboratories? J Clin Microbiol 2017; 55: 638-640.
21. Sharp A, Borman AM, Perera N, Randle M, Braham S, Taori S, et al. Assessing routine diagnostic methods for detecting Candida auris in England. J Infect 2018; 77: 448-454.
22. Prakash A, Sharma C, Singh A, Kumar Singh P, Kumar A, Hagen F, et al. Evidence of genotypic diversity among Candida auris isolates by multilocus sequence typing, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and amplified fragment length polymorphism. Clin Microbiol Infect 2016; 22: 277. e1-9.
23. Kathuria S, Singh PK, Sharma C, Prakash A, Masih A, Kumar A, et al. Multidrug-resistant Candida auris misidentified as Candida haemulonii: characterization by matrix-assisted laser desorption ionization-time of flight mass spectrometry and DNA sequencing and its antifungal susceptibility profile variability by Vitek 2, CLSI broth microdilution,and Etest method. J Clin Microbiol 2015; 53: 1823-1830.
24. Ahmad S, Alfouzan W. Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal susceptibility, and infection control measures to combat the spread of infections in healthcare Facilities. Microorganisms 2021; 9: 807.
25. Perry JD. A decade of development of chromogenic culture media for clinical microbiology in an era of molecular diagnostics. Clin Microbiol Rev 2017; 30: 449-479.
26. Scharmann U, Kirchhoff L, Chapot VLS, Dziobaka J, Verhasselt HL, Stauf R, et al. Comparison of four commercially available chromogenic media to identify Candida albicans and other medically relevant Candida species. Mycoses 2020; 63: 823-831.
27. Willinger B, Hillowoth C, Selitsc B, Manafi M. Performance of Candida ID, a new chromogenic medium for presumptive identification of Candida species, in comparison to CHROMagar Candida. J Clin Microbiol 2001; 39: 3793-3795.
28. Sharma U, Patel K, Shah V, Sinha S, Rathore VPS. Isolation and speciation of Candida in Type II diabetic patients using CHROM Agar: a microbial study. J Clin Diagn Res 2017; 11: DC09-DC11.
29. Sharp A, Muller-Pebody B, Charlett A, Patel B, Gorton R, Lambourne J, et al. Screening for Candida auris in patients admitted to eight intensive care units in England, 2017 to 2018. Euro Surveill 2021; 26: 1900730.
30. Rudramurthy SM, Chakrabarti A, Paul RA, Sood P, Kaur H, Capoor MR, et al. Candida auris candidaemia in Indian ICUs: analysis of risk factors. J Antimicrob Chemother 2017; 72: 1794-1801.
31. Chakrabarti A, Sood P, Rudramurthy SM, Chen S, Kaur H, Capoor M, et al. Incidence, characteristics and outcome of ICU-acquired candidemia in India. Intensive Care Med 2015; 41: 285-295.
32. Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill 2018; 23: 1800516.
33.Rowlands J, Dufort E, Chaturvedi S, Zhu Y, Quinn M, Bucher C, et al. Candida auris admission screening pilot in select units of New York city health care facilities, 2017-2019. Am J Infect Control 2023; 51: 866-870.
34. Zarei Mahmoudabadi A, Rezaei-Matehkolaei A, Navid M, Torabizadeh M, Mazdarani S. Colonization and antifungals susceptibility patterns of Candida species isolated from hospitalized patients in ICUs and NICUs. J Nephropathol 2015; 4: 77-84.
35. Yang YL, Leaw SN, Wang AH, Chen HT, Cheng WT, Lo HJ. Characterization of yeasts colonizing in healthy individuals. Med Mycol 2011; 49: 103-106.
36. Schulte DM, Sethi A, Gangnon R, Duster M, Maki DG, Safdar N. Risk factors for Candida colonization and Co-colonization with multi-drug resistant organisms at admission. Antimicrob Resist Infect Control 2015; 4: 46.
37. Mulet Bayona JV, Salvador García C, Tormo Palop N, Gimeno Cardona C. Evaluation of a novel chromogenic medium for Candida spp. identification and comparison with CHROMagar™ Candida for the detection of Candida auris in surveillance samples. Diagn Microbiol Infect Dis 2020; 98: 115168.
38. de Jong AW, Dieleman C, Carbia M, Mohd Tap R, Hagen F. Performance of two novel chromogenic Media for the identification of multidrug-resistant Candida auris compared with other commercially available formulations. J Clin Microbiol 2021; 59(4): e03220-20.
39. Kumar A, Sachu A, Mohan K, Vinod V, Dinesh K, Karim S. Simple low cost differentiation of Candida auris from Candida haemulonii complex using CHROMagar Candida medium supplemented with Pal's medium. Rev Iberoam Micol 2017; 34: 109-111.
40. Ruiz-Gaitán A, Sigona-Giangreco I, Pérez-Royo JM, Garcia-Bustos V, García-Hita M, Valentín-Gómez E, et al. Usefulness of chromogenic media with fluconazole supplementation for presumptive identification of Candida auris. Diagnostics (Basel) 2023; 13: 231.
| Files | ||
| Issue | Vol 16 No 5 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v16i5.16807 | |
| Keywords | ||
| Screening; Candida; Colonization; Infection; Resistant | ||
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How to Cite
1.
Sachu A, Sudersanan H, Sunny S, Mathew P, Kumar A, David A. Is routine screening for Candida auris necessary in ICU?. Iran J Microbiol. 2024;16(5):708-715.
