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. 2016 Oct 19:5:35.
doi: 10.1186/s13756-016-0132-5. eCollection 2016.

First hospital outbreak of the globally emerging Candida auris in a European hospital

Silke Schelenz  1 , Ferry Hagen  2 , Johanna L Rhodes  3 , Alireza Abdolrasouli  3 , Anuradha Chowdhary  4 , Anne Hall  5 , Lisa Ryan  5 , Joanne Shackleton  5 , Richard Trimlett  6 , Jacques F Meis  7 , Darius Armstrong-James  1 , Matthew C Fisher  3
Affiliations

First hospital outbreak of the globally emerging Candida auris in a European hospital

Silke Schelenz et al. Antimicrob Resist Infect Control. .

Abstract

Background: Candida auris is a globally emerging multidrug resistant fungal pathogen causing nosocomial transmission. We report an ongoing outbreak of C. auris in a London cardio-thoracic center between April 2015 and July 2016. This is the first report of C. auris in Europe and the largest outbreak so far. We describe the identification, investigation and implementation of control measures.

Methods: Data on C. auris case demographics, environmental screening, implementation of infection prevention/control measures, and antifungal susceptibility of patient isolates were prospectively recorded then analysed retrospectively. Speciation of C. auris was performed by MALDI-TOF and typing of outbreak isolates performed by amplified fragment length polymorphism (AFLP).

Results: This report describes an ongoing outbreak of 50 C. auris cases over the first 16 month (April 2015 to July 2016) within a single Hospital Trust in London. A total of 44 % (n = 22/50) patients developed possible or proven C. auris infection with a candidaemia rate of 18 % (n = 9/50). Environmental sampling showed persistent presence of the yeast around bed space areas. Implementation of strict infection and prevention control measures included: isolation of cases and their contacts, wearing of personal protective clothing by health care workers, screening of patients on affected wards, skin decontamination with chlorhexidine, environmental cleaning with chorine based reagents and hydrogen peroxide vapour. Genotyping with AFLP demonstrated that C. auris isolates from the same geographic region clustered.

Conclusion: This ongoing outbreak with genotypically closely related C. auris highlights the importance of appropriate species identification and rapid detection of cases in order to contain hospital acquired transmission.

Keywords: AFLP Genotyping; Candida auris; Healthcare-associated infections; Outbreak.

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Figures

Fig. 1
Fig. 1
New cases of C. auris per month. Total number of monthly new cases of C. auris are listed from the 1 April 2015 to the end of July 2016
Fig. 2
Fig. 2
AFLP typing and of C. auris. UPGMA dendrogram of AFLP fingerprint analysis and an AFLP-derived minimum spanning tree of C. auris isolates from the UK (n = 15) compared to those from India (n = 22), Japan (n = 1), South Africa (n = 4), South Korea (n = 2), and Venezuela (n = 19). Isolates from the closely related sibling species C. haemulonii (n = 11), C. duobushaemulonii (n = 12) and C. pseudohaemulonii (n = 3) were included to serve as an outgroup. Cluster analysis showed that all species form distinct clusters based on the AFLP fingerprint profiles, demarcated by the black dendrogram lines or in the minimum spanning tree where branch lengths indicates the similarity between isolates with thick solid lines (up to 14.96), thin solid line (up to 29.25), thick dashed lines (up to 43.54), thin dashed lines (up to 57.83) and thin dotted lines (above 57.83). C. auris isolates that came from the same geographic region clustered together
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