Large C. auris outbreak in UK ICU linked to thermometers
Researchers linked one of the largest Candida auris outbreaks ever reported to thermometer use at a neurosciences ICU in the United Kingdom.
David Eyre, DPhil , of the Nuffield Department of Medicine at the University of Oxford and colleagues reported that the outbreak, which affected 70 patients at the Oxford University Hospitals NHS Foundation Trust between February 2015 and August 2017, highlights the important role of environmental C. auris transmission in health care settings.
“C. auris, which is an emerging multidrug-resistant threat, can spread by persisting in the environment, in particular on multipatient-use equipment,” Eyre told Infectious Disease News. “With any health care-associated outbreak, environmental transmission should be considered, and the environment sampled if there is no other explanation.”
Of the 70 patients colonized or infected with C. auris during the outbreak, 94% were admitted to the neurosciences ICU before being diagnosed, according to the researchers. All outbreak isolates were resistant to fluconazole, and most were resistant voriconazole (98%) and posaconazole (90%).
The median duration of C. auris colonization was 39 days. However, some patients were still colonized upon discharge, according to Eyre.
“We can’t say whether they have all cleared their colonization,” he said.
Only seven patients developed an invasive C. auris infection, one of whom died. The remaining six patients were successfully treated. The researchers found no evidence that C. auris colonization or infection significantly increased the risk for mortality (HR = 1.21; 95% CI, 0.64-2.29).
During their investigation, the researchers rarely detected C. auris in the general environment. However, it was found on multipatient-use equipment, including axillary skin-surface temperature probes. Eyre said it took approximately 6 months to connect the thermometers — which were used in 86% of patients treated in the neurosciences ICU — to the outbreak.
Thermometer use was an independent predictor of C. auris colonization and infection, even after adjusting for length of neurosciences ICU stay, patient physiology and biomarkers. Despite implementing infection control interventions, the outbreak was contained only when the thermometers were removed.
“This reinforces the need to carefully investigate the environment, and in particular, multiuse patient equipment,” Eyre said in a press release. – by Stephanie Viguers
Eyre D, et al. Abstract O0172. Presented at: European Congress of Clinical Microbiology and Infectious Diseases; April 21-24, 2017; Madrid.
Disclosure: Eyre reports no relevant financial disclosures.