Candida auris in Healthcare Facilities, New York, USA, 2013-2017

Abstract

Candida auris is an emerging yeast that causes healthcare-associated infections. It can be misidentified by laboratories and often is resistant to antifungal medications. We describe an outbreak of C. auris infections in healthcare facilities in New York City, New York, USA. The investigation included laboratory surveillance, record reviews, site visits, contact tracing with cultures, and environmental sampling. We identified 51 clinical case-patients and 61 screening case-patients. Epidemiologic links indicated a large, interconnected web of affected healthcare facilities throughout New York City. Of the 51 clinical case-patients, 23 (45%) died within 90 days and isolates were resistant to fluconazole for 50 (98%). Of screening cultures performed for 572 persons (1,136 total cultures), results were C. auris positive for 61 (11%) persons. Environmental cultures were positive for samples from 15 of 20 facilities. Colonization was frequently identified during contact investigations; environmental contamination was also common.

Keywords: Candida auris; New York; United States; epidemiology; fungi; healthcare facilities; infection control; yeast.

Figure 1

Number of confirmed clinical cases of Candida auris in New York, USA, May 2013–April 2017. Dates indicate the month that the first sample positive for C. auris was collected. The cases from May 2013, April 2016, and June 2016 were retrospectively identified after the June 2016 clinical alert from the Centers for Disease Control and Prevention was issued (19). The case from 2013, in a patient who had traveled to New York City from abroad for medical care, was probably a distinct importation with no further spread.

Figure 2

Epidemiologic links between healthcare facilities affected by Candida auris, New York, USA, 2013–2017. Arrows between facilities denote transfer of case-patients from one facility to the other within 90 days before collection date of first positive culture. Bold arrows indicate transfer of >1 case-patient. Bold boxes indicate hospitals; nonbold boxes indicate long-term care facilities; boxes with roofs indicate private residences. Numbers indicate numbers of clinical cases (C) and screening cases (S) at that facility. Screening cases are placed at the facility of diagnosis. Clinical cases are also shown at the facility of diagnosis unless the specimen was collected during the first week of admission at the diagnosing facility; in such situations, the cases are shown at the previous facility.

Figure 3

Long-term Candida auris colonization of clinical and screening case-patients, New York, USA, 2013–2017. Each patient for whom follow-up cultures were performed is represented by a horizontal line. The bottom 30 lines (pink shading) indicate clinical case-patients; the top 8 (blue shading) indicate screening case-patients. Follow-up cultures were collected from a variety of sites, typically axilla and groin and often nares, rectum, urine, and wounds. Persons were considered free of colonization with C. auris and eligible for removal of contact precautions when 2 sets of surveillance cultures at multiple sites, taken at least 1 week apart, were negative; only 1 person indicated on the figure (second from bottom) met this criterion.