Emergence and Spread of Candida auris in New York State

BACKGROUND: Candida auris, an emerging yeast, has been detected in New York State (NYS). C. auris is often resistant to antifungal medications and has caused healthcare-associated outbreaks. We describe the emergence and spread of C. auris in NYS in multiple healthcare facilities. METHODS: C. auris cases were identified through active or passive surveillance. Isolates were identified using matrix-assisted laser desorption/ionization-time of flight mass spectrometry, and antifungal susceptibility testing was performed. Cases of C. auris were classified as clinical or screening depending on the reason for culture (diagnostic or surveillance). Invasive cases of Candida haemulonii were classified as probable if the yeast identification method used could not reliably identify C. auris and the isolate was not available. Surveillance methods included culturing contacts, conducting point prevalence surveys, and collecting environmental cultures. Facility site visits were conducted to review infection control practices when transmission was suspected. RESULTS: As of May 15, 2017, 53 clinical, 17 screening, and four probable cases had been reported. Twenty-three of the 53 clinical cases died. Clinical cases were identified in 18 hospitals, one long-term acute care hospital (LTACH), and one private medical office, but the cases passed through 24 hospitals, 24 long-term care facilities, and one LTACH in the 90 days before diagnosis through May 15, 2017. Although the facilities were located eight counties, 42 of 53 (79%) of the cases were residents in three downstate metropolitan counties. Site visits identified areas for improvement in infection control, including adherence to recommended hand hygiene practices, standard and contact precautions, and environmental cleaning practices. Isolates from 52 of 53 clinical cases were resistant to fluconazole. Amphotericin B susceptibility varied. Initial isolates from all clinical cases were susceptible to echinocandins; one case developed echinocandin resistance during treatment. CONCLUSION: C. auris has emerged as a novel pathogen in NYS and has been detected in multiple healthcare facilities. The spread to many facilities likely reflects the challenges of detection and demonstrates the need for strict infection control practices. DISCLOSURES: All authors: No reported disclosures.