NYC monitors patients colonized with C. auris upon their release
ATLANTA — A case management program piloted by the New York City health department monitors patients colonized with Candida auris after they are discharged into the community and notifies health care facilities of their status, researchers reported at the CDC’s annual Epidemic Intelligence Service conference.
C. auris is an invasive and often multidrug-resistant fungus that has emerged over the past decade as an important cause of hospital outbreaks. In the United States, 613 clinical cases of C. auris have been reported to the CDC, with more than half occurring in New York City. Targeted screening in eight states has found more than 1,100 additional patients who are colonized with C. auris, according to the CDC.
Patients can remain colonized with C. auris for months in a health care setting, but it is unclear if they remain colonized after discharge, noted Genevieve Bergeron, MD, MPH, an Epidemic Intelligence Service officer with the New York City Department of Health and Mental Hygiene (DOHMH), and colleagues.
According to Bergeron and colleagues, the state health department began referring patients colonized with C. auris to the DOHMH on Oct. 4, 2017. Approximately 12 case managers handled the referrals, conducting patient interviews and reviewing medical records to obtain relevant clinical information. They informed the patients’ providers and health care facilities about their C. auris status and infection control needs.
“We requested that facilities flag the patient in their electronic medical records to ensure that the patient has the proper precautions, if the patient were to seek care again at those facilities,” Bergeron said in a presentation. “Case mangers sent a medical alert card to the patients for them to use when encountering health care providers unaware of their infection control needs.”
Additionally, using syndromic surveillance data, Bergeron and colleagues created a system that alerted them when a colonized patient visited an ED in New York City.
“Syndromic data [do] not include a patient’s name, but [they include] a patient’s date of birth, sex and home zip code,” Bergeron said. “We automated an hourly query of the syndromic database to identify ED visits that match the patients in the C. auris outpatient program.”
According to Bergeron, they received data at least every 24 hours from 50 out of 53 EDs and urgent care facilities in the city, including 35 that reported it every hour.
“From March 2018 to March 2019, we had up to 18 alerts per month for up to 73 patients,” Bergeron said. “We received 159 alerts; 85% of them were true matches. Eighteen facilities were unaware of the patient’s C. auris colonization status and were informed by our call. This represents 13% of true matches.”
Under the case management program, case managers tested patients for colonization every 3 months. If C. auris was not detected, repeat testing occurred at least 1 week later to confirm the results, Bergeron and colleagues reported.
The DOHMH received 85 referrals, and 33 patients were included in the preliminary analysis. According to Bergeron’s presentation, 24 patients had no detectable C. auris isolates when tested in two consecutive assessments. The other nine patients were persistently colonized with C. auris.
Clinical cases were defined as any individual who had an infection caused by C. auris, whereas screening cases were defined as asymptomatic persons with a positive C. auris surveillance culture, Bergeron noted.
“Clinical cases were more likely to remain persistently colonized over time than screening cases,” she said.
The researchers noted that further data collection is needed to identify factors associated with persistent C. auris colonization.
“One challenge was that actively supporting infection control for C. auris and monitoring colonization status over time is resource intensive,” Bergeron said. “Continued data collection will help increase the number of patients in the analysis and will allow [us] to monitor patients whether patients cleared colonization with more time and the risk factors associated with persistent colonization.” – by Marley Ghizzone
Bergeron G, et al. Candida auris colonization in the community setting — New York City, 2017-2018. Presented at: Epidemic Intelligence Service conference; April 29-May 2, 2019; Atlanta.
Disclosures: The authors report no relevant financial disclosures.