Candida auris colonization was found in a Maryland hospital patient who was previously hospitalized in Kenya — thus emphasizing the importance of identifying risk factors for this emerging infection, CDC researchers said.
Healthcare exposure outside the U.S. is an important such factor, even if C. auris is not known to be widespread in that country, and healthcare facilities should follow CDC guidelines that recommend screening for C. auris colonization if any patient has an overnight stay in a healthcare facility abroad any time in the last year.
“Health care facilities should develop strategies to consistently and reliably obtain patients’ travel histories for medical care received outside of the United States in order to identify patients to be screened, and patients should inform their health care providers about any health care received abroad to inform their care” wrote Richard B. Brooks, MD, of the CDC, and colleagues in the Morbidity and Mortality Weekly Report.
Earlier this week in a commentary in the Annals of Internal Medicine, co-author Snigdha Vallabhaneni, MD, of the CDC, and colleagues, listed overnight stays in healthcare facilities outside the U.S. as one risk factor for C. auris.
Not only does the CDC recommend screening patients with an overnight stay in a health care facility outside the U.S. for C. auris, but patients with overnight hospitalization abroad in the last 6 months should be placed on contact precautions, and screened for carbapenem-producing organisms like carbapenem-resistant Enterobacteriaceae.
This particular case study details a patient medically evacuated from Kenya to an acute hospital in Maryland, and placed on contact precautions. In Kenya, the patient underwent several operations, including arterial clipping and placement of a tracheostomy and a feeding tube, the authors said. They added that the patient also developed sepsis, pneumonia, and a urinary tract infection and was treated with broad-spectrum antibiotics and at least one course of antifungal medications in Kenya.
Researchers noted that the patient had ongoing fevers, and specimens collected at admission revealed the growth of oxacillinase-48-like-producing carbapenem-resistant Klebsiella pneumoniae in urine and New Delhi metallo-beta-lactamase-producing carbapenem-resistant Pseudomonas aeruginosa in sputum. However, they added, while C. auris had been detected in a hospital in Kenya, it was not in the facility where the Maryland patient was hospitalized.
Maryland Department of Health, in consultation with the CDC, recommended that the patient be evaluated for C. auris colonization. Once the patient was identified as being colonized by C. auris, 21 patients in the same hospital unit were evaluated, but all screened negative.
The authors noted that transmission was likely prevented because of the hospital’s use of contact precautions and “rapid recognition” of the patient’s risk for multi-drug resistant organism colonization.
“Early identification of C. auris is critical to preventing further transmission,” they said.
The authors disclosed no conflicts of interest.
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