A study of hospital patients in Florida indicates that multiple comorbidities and invasive devices are significantly associated with progression from Candida auris colonization to infection, researchers reported last week in Clinical Infectious Diseases.

In one of the largest analyses of its kind, researchers from the Centers for Disease Control and Prevention and the Florida Department of Health used a case-control methodology to investigate factors associated with C auris infection after prior colonization among patients identified in Florida healthcare facilities from 2019 through 2023. An estimated 4,000 hospital patients in Florida have been colonized or infected with the multidrug-resistant yeast since it was first identified in the state in 2017, but why some patients develop clinical signs and symptoms while others remain colonized is unclear.

"Knowledge of the factors associated with progression to clinical infection can be used to improve facility testing protocols, healthcare provider knowledge, and infection prevention and control (IPC) measures to improve patient outcomes," the study authors wrote.

Age, low patient functional status among risk factors

After reviewing the records of 1,073 patients, the researchers identified 105 case-patients (median age, 64 years) with documented clinical specimens after colonization and 578 control subjects (median age, 69 years) with colonization only. Unadjusted measures revealed several factors that were significantly associated with progression to clinical cases, including the presence of five or more comorbid conditions (odds ratio [OR], 10.02; 95% confidence interval [CI], 4.07 to 24.7), four or more invasive devices (OR, 2.92; 95% CI, 1.70 to 5.03), or three or more recent medical procedures (OR, 2.32; 95% CI, 1.19–4.55). 

Other factors included fully dependent care required for eating (OR, 2.80), limited mobility (OR, 2.15), inability to transfer (OR, 1.82), and being in the 50- to 64-year-old age-group (OR, 1.77).

The authors say healthcare facilities could consider prioritizing high-acuity patients for early C auris screening, transmission-based precautions, and infection prevention interventions.

"Further analysis to understand clinical implications and risk factors for C. auris progression after colonization is needed," they concluded. "Future efforts might include an adjusted analysis to more fully understand the risk that individual medical conditions and functional status have on C. auris clinical outcomes."

The use of permethrin-treated cloth baby wraps among mothers of 6- to 18-month-old children in Uganda reduced clinical malaria infections in the babies by 66%, according to a study published in the New England Journal of Medicine.

Researchers at the University of North Carolina at Chapel Hill and the Mbarara University of Science and Technology in Uganda conducted a double-blind, randomized, controlled trial among women with a child aged 6 to 18 months old from June 2022 through April 2024 to determine if the insecticide lowered rates of the mosquito-borne illness. 

The 400 mother–child pairs were randomly assigned in a 1:1 ratio to use permethrin-treated baby wraps (intervention group) or sham-treated wraps (control group). The wraps were retreated every 4 weeks, and all participants were given a new, pyrethroid-treated bed net.

Participants visited a trial clinic every 2 weeks for 24 weeks and made unscheduled visits if their child developed a fever. Clinical malaria was defined as fever and a positive malaria rapid diagnostic test.

"We leveraged the traditional practice of mothers carrying children on their backs in cloth wraps to assess whether treating the wraps with an insect repellent might provide a layer of protection against malaria," the study authors wrote. The wraps also serve as a blanket or swaddle when the children are set on the ground and in bed.

Integration with cultural norms

Clinic attendance was 99.9%. The incidence of clinical malaria was 0.73 cases per 100 person-weeks (95% confidence interval [CI], 0.51 to 1.02) in intervention recipients and 2.14 per 100 person-weeks (95% CI, 1.73 to 2.62) in controls (incidence rate ratio, 0.34), for a 66% reduction. Intervention recipients reported rash more often than controls (8.5% vs 6.0%).

We leveraged the traditional practice of mothers carrying children on their backs in cloth wraps to assess whether treating the wraps with an insect repellent might provide a layer of protection against malaria.

"Treatment of these wraps has potential advantages, including the ability to target young children (who are most vulnerable to the severe manifestations of malaria, including death), integration with existing cultural norms, protection against outdoor and daytime mosquito biting, and the minimization of direct contact with permethrin because the wrap is worn over clothing," the researchers concluded.