Midsection of female doctor with swab test sample during COVID-19 crisis. Female medical professional is holding test tube in hospital. She is wearing protective suit.

A project that implemented targeted screening for candida auris in ventilator-assisted healthcare facilities has found relatively high rates of colonization in nursing homes, and evidence that testing at admissions helps prevent and control outbreaks.

Candida auris is a deadly fungus that often crops up in long-term care settings. It resists not only antifungal drugs, but also cleaning efforts, and is found on surfaces all over affected facilities. A 2019 study in long-term care facilities found that it sheds with patients’ skin, helping to explain widespread contamination when it takes hold in a healthcare setting.

The new project took place in three facilities in New York City. Screenings were targeted to patients at high risk of testing positive upon their admission to ventilator units in two nursing homes and to ventilator, cardiac care and intensive care units in one hospital. High-risk factors included previous healthcare exposure to C. auris.

Clinical staff collected two swabs from patients, to be tested by reverse transcription polymerase chain reaction (rt-PCR). 

Risk factors revealed

Screening with rt-PCR tests proved to be useful in identifying patients colonized with C. auris, allowing clinicians to implement transmission control measures, lead author Emily Lutterloh, MD, MPH, of State University of New York at Albany reported. 

Cases of C. auris were more likely to be identified through the armpit/groin swab than the nasal swab, investigators found. The data also pinpointed key risk factors for testing positive. These included admission to a healthcare facility or nursing home in the past 90 days, intubation, the presence of an indwelling medical device, and receipt of an antifungal medication in the prior seven days.

Labor-intensive detection

Targeted admission screening helped to “maximize the likelihood of identifying cases while minimizing the screening of individuals likely to be negative,” Lutterloh and colleagues said. But the admission screening process was labor-intensive, the researchers found. It required approximately 30 minutes per individual screened, according to staff at all of the participating facilities. 

Notably, the highest rates of colonized patients were found in nursing home ventilator units when compared to any of the units within the hospital, the study authors reported. And within the hospital, the ventilator/pulmonary unit had the most cases.

Health authorities on alert

C. auris and other infectious fungi have received increased attention from U.S. and global health authorities as more become multi-drug resistant. In 2021, the Centers for Disease Control and Prevention for the first time identified infections from C. auris in nursing homes and hospitals that resist all first-line antifungal treatments. And in October 2022, C. auris was included in the World Health Organization’s first-ever priority list of fungi that it says pose the greatest emerging threats to public health.

The study was published in the American Journal of Infection Control.

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