Containment of a Multi-facility Outbreak of Candida Auris in a Texas Metropolitan Area During COVID-19 Pandemic

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities are experiencing shortages of staff, personal protective equipment (PPE), environmental disinfectants, and patient beds. Candida auris, a fungus often resistant to common antifungals, requires staff to wear gown and gloves and use the correct surface disinfectant. A regional epidemiology approach is needed when a multi-facility outbreak occurs. METHODS: In May 2021, an acute care hospital reported a clinical C. auris case to the local health department (LHD). Discussions were initiated between LHD and state partners on the Centers for Disease Control and Prevention (CDC) tiered C. auris approach. Infection Control Assessment Responses (ICARs) were conducted at identified facilities and point prevalence studies were initiated upon identification of infection control gaps. LHD implemented aggressive colonization testing and isolation protocol after discussions with CDC and state partners. Active surveillance was implemented throughout the jurisdiction. An interfacility transfer form helped communicate isolation needs during patient transfers. C. auris isolates confirmed at the state laboratory were sent to the Antibiotic Resistance (AR) Laboratory Network laboratory. Whole genome sequencing (WGS) was performed by the CDC Laboratory. RESULTS: From May through October 2021, the LHD received 149 C. auris case reports. Collection dates ranged from May 1, 2021, to October 15, 2021. Sixteen were clinical cases and 133 were colonized cases. Of the 149 cases, 55% (n=82) were males. Ages ranged from 24 years to 90 years with a mean and median of 65 years. Of the 1725 screening swabs tested, 8% (n=133) were positive for C. auris. Twenty-two ICARs were conducted. WGS was performed on 15 isolates, which showed relatedness between the isolates. CONCLUSIONS: AR testing helped epidemiologists identify colonized C. auris cases that would have otherwise not been identified. WGS results supported the epidemiology data showing relatedness between the cases and indicated transmission within and between facilities.