Study highlights spread of C auris in skilled nursing facilities
Point prevalence surveys at high-acuity long-term care facilities in Chicago indicate that ventilator-capable skilled nursing facilities (vSNFs) are particularly vulnerable to Candida auris, a research team led by the Chicago Department of Public Health reported yesterday in Clinical Infectious Diseases.
The surveys were conducted from August 2016 through December 2018 to identify patients colonized with C auris and assess infection control (IC) measures in the city's high-acuity long-term care facilities, where ongoing spread of the pathogen has been documented since the first two cases of the multidrug-resistant fungus were identified in Chicago in August 2016.
The 47 surveys conducted in 18 facilities identified 490 patients infected (128) or colonized (362) with C auris, and found that the highest prevalence of C auris colonization was in vSNFs (median prevalence, 66%) and long-term acute care hospitals (median prevalence, 31%). IC assessments identified lack of staff member time dedicated to IC activities, lack of infection surveillance systems, and lack of personal protective equipment as common challenges.
A case study and repeat point prevalence surveys conducted at a single vSNF from January 2018 through October 2018 found that C auris prevalence increased from 43% to 71% over 10 months, that most residents remained persistently colonized with C auris, and that 39% of environmental samples collected tested positive for the pathogen. C auris was detected in samples collected from over-bed tables, bedside chairs, nursing carts, doorknobs, bedrails, and windowsills.
"High-acuity long-term healthcare facilities represent high priority settings for public health interventions to contain spread of emerging healthcare-associated MDROs [multidrug-resistant organisms]," the researchers wrote. "Strategies are needed to improve adherence to infection control practices."
According to the most recent case count from the US Centers for Disease Control and Prevention (CDC), there are 1,018 confirmed and probable C auris infections in 16 states, and an additional 2,051 patients who are colonized. Illinois has the second-highest number of cases, at 292, behind New York (465).
Apr 14 Clin Infect Dis abstract
Feb 2 CDC C auris case count
CDC researchers find MDR Salmonella strain in US travelers
In a research letter today in Emerging Infectious Diseases, CDC researchers reported the identification of a strain of multidrug-resistant (MDR) Salmonella previously found in Taiwan among US patients with a history of travel to Asia.
Using the National Center for Biotechnology Information Pathogen Detection Isolates Browser—a database of bacterial isolates from patients, food, and the environment—the researchers analyzed the genome sequences of 37 isolates genetically related to Salmonella enterica serotype Anatum, an MDR Salmonella strain that emerged in Taiwan in 2011.
Twenty-five of the isolates were from Taiwan, and 12 were from the United States, including 7 from people, 4 from tilapia imported from Taiwan, and 1 from shrimp imported from the Philippines.
The isolates harbored 11 antibiotic resistance genes, including blaDHA-1, a plasmid-mediated AmpC beta-lactamase gene, and the MCR-1.1 colistin-resistance gene. Antibiotic susceptibility testing indicated resistance to multiple antibiotic classes, including three recommended for treating Salmonella infections.
All 7 US patients reported diarrhea, abdominal pain, nausea, and fever, and 4 became ill after returning from the Philippines. Two others travelled to the Philippines and Taiwan, but travel and illness onset dates were not available. One patient had never travelled internationally, but her isolate was genetically similar to the isolate from shrimp imported from the Philippines. Before illness onset, she ate shrimp at an Asian restaurant.
"Our findings underscore the need for global, One Health surveillance," the authors write. "Given the extent of international travel and trade, data sharing among human health, animal health, and food production sectors and across geographic borders is essential to detect MDR strains and inform strategies and interventions to prevent spread."
Apr 15 Emerg Infect Dis study