First hospital outbreak of the globally emerging Candida auris in a European hospital

TLDR

Candida auris is a globally emerging multidrug‑resistant fungal pathogen that causes nosocomial transmission. We investigated an ongoing outbreak of 50 C. auris cases in a London cardio‑thoracic center (April 2015–July 2016), performing MALDI‑TOF speciation, AFLP typing, and prospectively recording demographics, environmental screening, antifungal susceptibility, and implementing strict infection‑control measures including isolation, PPE, patient screening, chlorhexidine decontamination, chlorine‑based cleaning, and hydrogen‑peroxide vapour.

Abstract

Candida auris is a globally emerging multidrug resistant fungal pathogen causing nosocomial transmission. We report an ongoing outbreak of C. auris in a London cardio-thoracic center between April 2015 and July 2016. This is the first report of C. auris in Europe and the largest outbreak so far. We describe the identification, investigation and implementation of control measures.Data on C. auris case demographics, environmental screening, implementation of infection prevention/control measures, and antifungal susceptibility of patient isolates were prospectively recorded then analysed retrospectively. Speciation of C. auris was performed by MALDI-TOF and typing of outbreak isolates performed by amplified fragment length polymorphism (AFLP).This report describes an ongoing outbreak of 50 C. auris cases over the first 16 month (April 2015 to July 2016) within a single Hospital Trust in London. A total of 44 % (n = 22/50) patients developed possible or proven C. auris infection with a candidaemia rate of 18 % (n = 9/50). Environmental sampling showed persistent presence of the yeast around bed space areas. Implementation of strict infection and prevention control measures included: isolation of cases and their contacts, wearing of personal protective clothing by health care workers, screening of patients on affected wards, skin decontamination with chlorhexidine, environmental cleaning with chorine based reagents and hydrogen peroxide vapour. Genotyping with AFLP demonstrated that C. auris isolates from the same geographic region clustered.This ongoing outbreak with genotypically closely related C. auris highlights the importance of appropriate species identification and rapid detection of cases in order to contain hospital acquired transmission.