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. 2022 Jun;65(6):643-649.
doi: 10.1111/myc.13443. Epub 2022 Apr 24.

Successful control of Candida auris transmission in a German COVID-19 intensive care unit

Carl Hinrichs  1 , Miriam Wiese-Posselt  2 , Barbara Graf  3 , Christine Geffers  2 , Beate Weikert  2 , Philipp Enghard  1 , Alexander Aldejohann  4   5 , Annette Schrauder  3 , Andreas Knaust  3 , Kai-Uwe Eckardt  1 , Petra Gastmeier  2 , Oliver Kurzai  4   5
Affiliations

Successful control of Candida auris transmission in a German COVID-19 intensive care unit

Carl Hinrichs et al. Mycoses. 2022 Jun.

Abstract

Background: Candida auris a frequently multidrug-resistant yeast species that poses a global health threat due to its high potential for hospital outbreaks. While C. auris has become endemic in parts of Asia and Africa, transmissions have so far rarely been reported in Western Europe except for Great Britain and Spain. We describe the first documented patient-to-patient transmission of C. auris in Germany in a COVID-19 intensive care unit (ICU) and infection control measures implemented to prevent further spread of the pathogen.

Methods: Identification of C. auris was performed by MALDI-TOF and confirmed by internal transcribed spacer (ITS) sequencing. Antifungal susceptibility testing was carried out. We conducted repeated cross-sectional examinations for the presence of C. auris in the patients of the affected ICU and investigated possible routes of transmission.

Results: The index patient had been transferred to Germany from a hospital in Northern Africa and was found to be colonised with C. auris. The contact patient developed C. auris sepsis. Infection prevention and control (IPC) measures included strict isolation of the two C. auris patients and regular screening of non-affected patients. No further case occurred during the subsequent weeks. Reusable blades used in video laryngoscope-guided intubation were considered as the most likely vehicle of transmission.

Conclusions: In view of its high risk of transmission, vigilance regarding C. auris colonisation in patients referred from endemic countries is crucial. Strict and immediate IPC measures may have the potential to prevent C. auris outbreaks.

Keywords: Candida auris; COVID-19; antifungal treatment; infection prevention and control measures.

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Conflict of interest statement

CH, MWP, BG, CG, BW, PE, AA, AS, AK, KUE, PG and OK do not report conflict of interest.

Figures

FIGURE 1
FIGURE 1
Clinical course of C. auris index and contact patients from Day 0 (admission of index patient) to Day 90 (transfer of index to rehabilitation clinic) with display of organ support, antifungal treatment and the timing of obtaining the most relevant microbiological samples with evidence of fungal infection/colonisation. Infection prevention and control (IPC) measures for suspected multidrug resistant bacterial colonisation were established immediately after admission of the index patient; tbs: tracheobronchial secretion, bc: blood culture, bal: bronchioalveolar lavage; C.: Candida; E.: Enterococcus; CRKP: carbapenem‐resistant Klebsiella pneumoniae; IPC: infection and prevention control
FIGURE 2
FIGURE 2
Reusable blade used for the video laryngoscope‐guided intubation in the COVID‐19 intensive care unit and identified as the likely route of C. auris transmission
See this image and copyright information in PMC

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