635. 'Urine' the Know: A Simple Approach for Detecting Candida auris Sooner, and the Emergence of Clade III Candida auris in NY

TL;DR

This study describes a new method for detecting Candida auris in urine samples and reports the emergence of a new strain in New York hospitals.

Contribution

The study introduces a modified urine culture protocol for early detection of Candida auris and reports the first New York cases of Clade III Candida auris.

Findings

A modified urine culture protocol successfully detected 67% of Candida auris cases.

All Candida auris isolates from patients and the environment were highly related genetically.

Inadequate cleaning practices and frequent patient transfers contributed to Candida auris transmission.

Abstract

Candida auris (CA) poses an urgent public health threat due to its multidrug resistance and associated mortality. Compared to other clades, Clade III CA (CA-III) may display increased environmental persistence and transmissibility. To date, we found no reports of Clade III in New York State. We sought to describe the genomic and clinical epidemiology of CA-III after a dual hospital outbreak in upstate NY.Table 1Candida auris baseline characteristicsFigure 1Hospital and room location of the Candida auris patients (A=hospital A; B=hospital B)

Candida auris baseline characteristics

Hospital and room location of the Candida auris patients (A=hospital A; B=hospital B)

Contact tracing and testing, environmental sampling, cleaning observations with intensified cleaning, and whole genome sequencing were performed. To minimize the risk of missing CA in mixed urine cultures, processing of routine urine cultures was modified such that all inpatient urine cultures yielding mixed results underwent an additional 24hr incubation at 35-37 °C, and any yeast isolated was identified to the species level.Table 2Single nucleotide polymorphism count of 5 patient and 1 environmental isolates

Single nucleotide polymorphism count of 5 patient and 1 environmental isolates

Case (n=6) characteristics appear in Table 1. 67% of cases were discovered via the modified urine protocol. On average, each patient had five prior admissions and 15 different rooms per stay (Table 1, Figure 1). All had invasive devices and considerable antibiotic exposure (Table 1). The outbreak began in the operating room, and later a common ward at hospital A became the epicenter of future cases. All isolates were highly related, differing by < /= 10 SNPs, including the only positive environmental culture from a bed (Table 2). Direct cleaning observations revealed that surface disinfectants were not given sufficient contact time on several occasions.

Our findings demonstrate the usefulness of a laboratory modification that is readily adaptable by most hospitals and does not require additional resources such as swabs, a PCR assay, or referral laboratory support. Moreover, unlike PCR screening, the urine protocol allows for susceptibility testing and WGS of isolates. This report re-demonstrates the role of antibiotic exposure in the emergence of CA. It also underscores the challenges of contact tracing given the frequent room transfers and re-admission rates typical among patients prone to CA acquisition. Last, our report highlights the role of shared equipment in transmission, and the criticality of appropriate cleaning and disinfectant use.

All Authors: No reported disclosures

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