384. Findings From a Candida auris Admission Screening Pilot in New York State

BACKGROUND: Candida auris is an emerging multidrug-resistant yeast which can spread within healthcare facilities and is associated with significant morbidity. Over 160 clinical cases have been reported in NYS. This pilot aims to assess the feasibility of C. auris admission screening and to better understand its role in controlling spread of C. auris in an area where it has emerged. METHODS: One hospital and two nursing homes (NHs) with known prior cases participated (one NH and hospital are closely associated and are reported together). Patients were screened on admission to any of three hospital intensive care units (medical, cardiac, pulmonary) or to a ventilator unit in the NHs from November 2017 to April 2018. Screening consisted of bilateral nares and axilla/groin swabs sent to the NYS Department of Health Wadsworth Center (WC) for a WC-developed C. auris real-time polymerase chain reaction (rt-PCR) test. Specimens with detection of C. auris on rt-PCR underwent fungal culture. Facilities were alerted of positive results and infection control precautions were promptly initiated. RESULTS: To date, 575 patients (1,371 samples) were screened. Of patients not previously known to be colonized, 39 had C. auris detected on rt-PCR; 34 confirmed by C. auris culture at either site and one culture pending. Of these, 30 (88%) were detected and confirmed from the axilla/groin specimen (Figure 1). Mean age was 76 years and 59% were females. Patients had significant healthcare facility exposure (Figure 2). Eleven (32%) were from NH-A and 23 (68%) from the hospital/NH-B combined. Rates of positivity were 16.2% (11/68) for NH-A and 4.6% (23/498) for the hospital/NH-B. CONCLUSION: C. auris rt-PCR is a useful tool within an admission screening program; however, more accessible and affordable rapid laboratory diagnostics are urgently needed. The axilla/groin site detected the majority of colonized individuals. Admission screening was feasible and increased facility knowledge of colonization status, which led to earlier implementation of infection control precautions potentially limiting spread. However, further study is needed to assess transmission dynamics and potential impact of admission screening on control of C. auris within an outbreak or endemic setting. DISCLOSURES: All authors: No reported disclosures.