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Candida auris Advisory (2017)

Candida auris in New Jersey

General Information for the Public

What is Candida auris?

C. auris is an emerging multi drug-resistant yeast that has caused outbreaks of invasive infections in healthcare facilities.

Why is C. auris a concern?

C. auris is often resistant to most antifungal drugs commonly used to treat Candida infections. Some strains of C. auris have elevated minimum inhibitory concentrations (MICs) to the three major classes of antifungals (polyenes, azoles, and echinocandins).

C. auris is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology. Misidentification may lead to inappropriate treatment.

C. auris has caused outbreaks in healthcare settings. For this reason, rapid identification of C. auris in healthcare settings is particularly important so that facilities can take special precautions to stop its spread.

Is there C. auris in New Jersey?

As of January 5, 2017, the Centers for Disease Control and Prevention (CDC) has received reports of at least 20 cases C. auris infection in the United States.

 Three infections have been reported in New Jersey residents and more than 15 cases have been reported in the downstate metropolitan region of New York State. However, because C. auris identification is difficult and the organism is not reportable, the true prevalence of C. auris in New Jersey and the United States is unknown.

Learn more about C. auris at www.cdc.gov/fungal/diseases/candidiasis/candida-auris-qanda.html

 

Information for Laboratories

When should laboratories suspect C. auris?

C. auris can be misidentified as:

o Candida haemulonii (typical identification by VITEK 2)

o Candida famata

o Candida sake

o Candida spp. (isolates where speciation is attempted and results are inconclusive)

o Saccharomyces cerevisiae

o Rhodotorula glutinis

Identification of any of these species should prompt further characterization using the identification methods described below.

Presence of resistance to one or more antifungal drug classes among these species should raise further concern that an isolate could be C. auris.

How can laboratories identify C. auris?

Diagnostic instruments based on matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS) can differentiate C. auris from other Candida species including Candida haemulonii. Laboratories should ensure they are strictly following manufacturer’s instructions when using MALDI-TOF instruments for Candida identification.

Molecular methods based on the sequencing of the internal transcribed spacer (ITS) and D1-D2 regions of the ribosomal gene can also identify C. auris.

Diagnostic methods other than MALDI-TOF and sequencing may not be able to distinguish C. auris from other yeasts, especially Candida haemulonii.

 

Information for Healthcare Facilities

What healthcare facilities might see patients with C. auris infections?

The majority of patients identified with C. auris infections have been immunocompromised and are suspected to have become infected in a healthcare setting.

C. auris infections have been identified in patients admitted to inpatient units of healthcare facilities, such intensive care units of hospitals or subacute units of long term care facilities.

 

What infection control precautions should be put in place when a patient is infected or colonized with C. auris?

Infection control is key to preventing spread of C. auris in healthcare facilities. Infection control measures should include:

o Placement of patients infected or colonized with C. auris on standard and contact precautions

o Placement of patients infected or colonized with C. auris in a single room, when possible

o If the patient cannot be placed on contact precautions, gloves and gowns should at least be worn by healthcare personnel during high-risk activities (e.g. dressing, changing linens, toileting, providing hygiene)

o Patient-specific equipment should be used whenever possible and any shared equipment should be thoroughly cleaned after use with an Environmental Protection Agency (EPA)-registered hospital-grade disinfectant with a fungal claim

o Ensure thorough daily and terminal cleaning of the patient’s room with an EPA-registered hospital-grade disinfectant with a fungal claim

o When a patient is transferred, provide prior notification of C. auris infection or colonization and the level of precautions recommended to the receiving healthcare facility

It is understood that long term care facilities may not be able to fully implement contact precautions or place patients in single rooms. These measures can be modified, as appropriate.

 

What infection control precautions should be used when C. auris is suspected by a laboratory, but not confirmed?

The same infection control measures should be implemented as if the patient had a confirmed infection, pending identification of the organism.

Limited data indicates that the risk factors for C. auris infections are the same as other types of Candida infections. Currently, there are no clinical criteria for clinicians to suspect C. auris over

other Candida species. Suspicion of a C. auris would be indicated by laboratory results as described in the “When should laboratories suspect C. auris?” section, above.

 

What treatments are suggested for C. auris infections?

 Please see the CDC’s interim recommendations for treatment at www.cdc.gov/fungal/diseases/candidiasis/recommendations.html

 

Reporting and Additional Questions

To report a confirmed or suspected case of Candida auris, please contact the Communicable Disease Service at 609-826-5964 or your local health department. To ask questions about C. auris, please contact the Antimicrobial Resistance Coordinator, Patricia Barrett, MSD, at 609-826-5964

January 23, 2017

 

 

Interim Recommendations for Healthcare Facilities and Laboratories

Candida auris is an emerging multi drug-resistant yeast that has caused outbreaks of invasive infections in healthcare facilities. C. auris has been identified in the United States, including infections in New Jersey and New York State residents. This organism is often resistant to antifungal drugs used to treat Candida infections and is difficult to identify using standard laboratory methods. The true prevalence of C. auris in New Jersey and the United States is unknown and the ability for C. auris identification is limited. The New Jersey Department of Health is providing the following recommendations to laboratories and healthcare facilities in order to identify any past or current C. auris infections in New Jersey.

Recommendations for Laboratories:

Laboratories should query laboratory information systems as far back as January 1, 2015 for isolates of:

o Candida auris

o Candida haemulonii

o Candida famata

o Candida sake

o Candida spp. (isolates where speciation is attempted and results are inconclusive)

o Saccharomyces cerevisiae

o Rhodotorula glutinis

 If reports of past isolates are identified, the information should be reported to the Communicable Disease Service (CDS) at 609-826-5964 or your local health department. Laboratories that are able to retrieve saved isolates should ensure isolate availability.

 If the above listed organisms are identified in current or future clinical isolates and C. auris is suspected, laboratories should notify CDS at 609-826-5964 or your local health department to arrange for further characterization by public health partners.

 Laboratories should see additional guidance from the Centers from Disease Control and Prevention (CDC) at www.cdc.gov/fungal/diseases/candidiasis/recommendations.html.

 

Recommendations for Healthcare Facilities

 Clinicians should suspect C. auris if laboratory results meet the criterion described in the “Recommendations for Laboratories” section, above.

 Healthcare facilities should implement appropriate infection control measures for patients with suspected or confirmed C. auris infection or colonization, including:

o Placement of patients in single rooms on standard and contact precautions

o Patient education on proper hand hygiene

o Glove and gown use by all healthcare personnel during high risk activities such as dressing, changing linens, toileting, and providing hygiene

o Use of patient-specific equipment whenever possible and thorough cleaning of shared equipment after use with an Environmental Protection Agency (EPA)-registered hospital-grade disinfectant with a fungal claim

o Thorough daily and terminal cleaning of the patient’s room with an EPA-registered hospital-grade disinfectant with a fungal claim

o Prior notification of C. auris infection or colonization and the level of precautions recommended to receiving healthcare facilities when a patient is transferred

 It is understood that long term care facilities may not be able to fully implement contact precautions or place patients in single rooms. These measures can be modified, as appropriate, in discussion with CDS.

 Suspected or confirmed C. auris infections or colonization should be reported to CDS at 609-826-5964 or local health department.

 Healthcare facilities should see additional guidance from the CDC at www.cdc.gov/fungal/diseases/candidiasis/recommendations.html.

Reporting and Additional Questions

To report a confirmed or suspected case of Candida auris, please contact the Communicable Disease Service at 609-826-5964 or your local health department. To ask questions about this guidance or learn more about C. auris, please see the accompanying document titled “Information about Candida auris in New Jersey” or contact the Antimicrobial Resistance Coordinator, Patricia Barrett, MSD, at 609-826-5964.

January 23, 2017