Oregon Health Authority is investigating an outbreak of the state’s first cases of Candida auris, a serious fungal infection that is often resistant to multiple antifungal medicines.
The Healthcare-Associated Infections Program at the OHA Public Health Division, working with a regional public health laboratory in Seattle and Salem Hospital, have identified Candida auris in three Salem Health patients. The first case was detected at Salem Hospital Dec. 11 in a patient who had recent international health care exposures, and confirmed Dec. 17.Candida auris has only recently appeared in the United States.
Two of the cases did not have international health care exposures, but had epidemiologic links to first case, indicating health care-associated spread of Candida auris to the second and third patients – identified Dec. 23 and Dec. 27, respectively.
The Healthcare-Associated Infections Program is leading the investigation, working with local public health authorities, local health care partners, the Centers for Disease Control and Prevention, and the regional public health laboratory to identify cases and ensure appropriate infection control measures are in place.
“Candida auris is an emerging pathogen of concern because it can cause serious infections, particularly in those with serious medical problems, and can be resistant to the antifungal drugs we have to treat it,” said Rebecca Pierce, Ph.D., Healthcare-Associated Infections Program manager. “Fortunately, the organism we’re dealing with in this outbreak appears to respond to existing treatments. Nonetheless, it’s critical that we prevent the spread of the infection.”
Jasmin Chaudhary, medical director of infection prevention at Salem Health, said the health system is taking action on a number of fronts to prevent the spread of Candida auris at Salem Hospital.
“With the COVID-19 pandemic, we have seen a rise in multi-drug resistant organisms around the world and nationwide, and Salem is not immune,” Chaudhary said. “Salem Health is working with OHA and the CDC to execute a rigorous plan, implementing aggressive eradication measures that have been shown in other hospitals to be successful in eliminating Candida auris. These include proactive steps that will assist in preemptively identifying new cases to prevent spread.”
Among the measures in effect: working with the patients’ care teams to ensure frequent and effective disinfection of the health care environment; using transmission-based precautions for those infected or colonized with Candida auris; adhering to hand hygiene protocols; and conducting effective interfacility-transfer communication about a patient’s Candida auris status when being transferred to another health care facility.
In addition, OHA and Salem Health have been coordinating to notify health care facilities that previously received transferred patients from affected units at Salem Health, and to support safe discharge of patients from Salem Health during the anticipated COVID-19 surge.
Candida auris is a type of yeast that can cause severe illness, particularly those suffering from serious medical conditions in hospitals and nursing homes. According to the CDC, patients who have been hospitalized in a health care facility for long periods, have a central venous catheter or other lines or tubes entering their body, or have weakened immune systems are at highest risk of infection and serious complications. The risk of Candida auris infection to otherwise healthy people, including health care personnel, is extremely low.
The fungus can cause serious infections, including bloodstream infections and wound infections. It also has been isolated from respiratory and urine specimens and can colonize patients’ skin. A laboratory test is needed to determine whether a patient is colonized or infected with Candida auris, but laboratories should be aware that it can be misidentified as other types of fungi and should know when to suspect Candida auris, as misidentification could delay treatment and control measures. Health care facilities that suspect they have a patient with Candida auris should contact their local public health authority immediately.
Since 2013, more than 1,150 clinical cases of Candida auris have been identified in the United States. There have never been any cases of the fungus identified in Oregon until now.
Patients who test positive or had a high-risk exposure will be contacted by Salem Health.
Visit the CDC’s Candida auris website at https://www.cdc.gov/fungal/candida-auris for more information.
Source: Oregon Health Authority