Preventing a Candida Auris Outbreak at an Acute Care Hospital During the COVID-19 Pandemic

BACKGROUND: Candida auris (C. auris) is a fungal pathogen that recently emerged and rapidly spread around the globe. It is now in California with 74 clinical cases according to the Centers for Disease Control and Prevention (August 31, 2020). C. auris can cause invasive disease with high mortality rates, is frequently resistant to one or more classes of antifungals, and can be difficult to identify. C. auris can also involve prolonged colonization of patients’ skin and contamination of surrounding environments, resulting in hospital outbreaks. The first known clinical case of C. auris in San Diego County was identified in an individual with recent hospitalization outside of the United States. The identification of this clinical case coincided with the first influx of COVID-19 patients. METHODS: The facility's carbapenemase-producing organism (CRO) screening program identified an individual who had recent hospitalization abroad. The patient was placed in a single room in pre-emptive Contact precautions. The patient tested positive for CRO colonization. The public health (PH) authorities asked that the patient be tested for C. auris colonization. While awaiting screening results, the hospital's microbiology laboratory identified C. auris in the patient's wound isolate. The C. auris case prompted the implementation of a robust infection prevention plan in collaboration with PH that included isolation precautions, environmental cleaning and disinfection and education. RESULTS: The patient required forty-seven days of hospitalization during the early days of the COVID-19 pandemic. The PH department recommended C. auris colonization screening for selected patients to check for transmission. Neither C. auris colonization nor clinical isolates were identified in the subsequent six months. CONCLUSIONS: A strong infection prevention response to the C. auris case prevented a potential outbreak. It is critical that acute-care hospitals are optimized to prevent the spread of C. auris during the COVID-19 pandemic.