Early Introductions of Candida auris Detected by Wastewater Surveillance, Utah, USA, 2022-2023.

Candida auris is considered a nosocomial pathogen of high concern and is currently spreading across the United States. Infection control measures for C. auris focus mainly on healthcare facilities, yet transmission levels may already be significant in the community before outbreaks are detected in healthcare settings. Wastewater-based epidemiology (culture, quantitative PCR, and whole-genome sequencing) can potentially gauge pathogen transmission in the general population and lead to early detection of C. auris before it is detected in clinical cases. To learn more about the sensitivity and limitations of wastewater-based surveillance, we used wastewater-based methods to detect C. auris in a southern Utah jurisdiction with no known clinical cases before and after the documented transfer of colonized patients from bordering Nevada. Our study illustrates the potential of wastewater-based surveillance for being sufficiently sensitive to detect C. auris transmission during the early stages of introduction into a community.

Candida auris Discovery through Community Wastewater Surveillance during Healthcare Outbreak, Nevada, USA, 2022.

Candida auris transmission is steadily increasing across the United States. We report culture-based detection of C. auris in wastewater and the epidemiologic link between isolated strains and southern Nevada, USA, hospitals within the sampled sewershed. Our results illustrate the potential of wastewater surveillance for containing C. auris.

A cluster investigation of Candida auris among hospitalized incarcerated patients.

Objective: Investigate and mitigate a cluster of Candida auris cases among incarcerated patients in a maximum-security prison hospital utilizing contact tracing, screening, whole genome sequencing, and environmental sampling and decontamination. Design: Outbreak investigation. Setting: Inpatient prison hospital affiliated with an academic tertiary referral center. Patients: Inmates of the Texas Department of Criminal Justice. Methods: Epidemiologic and environmental investigations were conducted including contact tracing, point prevalence surveys, and environmental sampling. Whole genome sequencing was performed on positive patient isolates. Results: Following a clinical case of C. auris fungemia, 344 patients underwent C. auris surveillance screening. Eight (2.3%) patients were identified with C. auris colonization. All patients were male. Our index patient was the only clinical case and death. Whole genome sequencing was performed on the nine patient isolates. All isolates were clade III (Africa) and clustered together with the largest SNP difference being 21. Environmental cultures from 7 of 61 rooms (11.5%) were positive following terminal disinfection with bleach. Sites nearest to the patient were most often positive including the hospital bed rails and bedside table. The transmission cluster was successfully mitigated within 60 days of identification. Conclusions: Implementation of an aggressive surveillance and decontamination program resulted in mitigation of a C. auris transmission cluster among our incarcerated patients. This investigation provides valuable insight into C. auris transmission in the incarcerated population, which is not considered a classic high-risk population as well as the challenges faced to stop transmission in a facility that requires the use of shared patient environments.

The Effects of Marriage and Being a Parent on Prenatal Physician Visits for Chamorro, Filipino, White and Other Asian and Pacific Island Women on Guam.

PURPOSE OF THE PAPER: The purpose of this study was to examine the effect of marital status, parental status, and ethnicity on the frequency of prenatal physician visitations reported by Chamorro, Filipino, White, and other Asian and Pacific Island women residing in Guam. SUMMARY OF METHODS UTILIZED: Data were extracted from birth records and analyzed using ordinary least squares multiple regression. PRINCIPAL FINDINGS: We found that ethnic effects remained even when age, education, and region of residence on Guam were held constant. Marriage had a significant and positive effect on prenatal visitations, and a number of previoius children had significant negative effect on prenatal visitations. CONCLUSIONS: We conclude that spouses encourage positive health behaviors while the expectations of parenting detract significantly from the amount of time women can devote to caring for themselves. RELEVANCE TO ASIAN AND PACIFIC ISLANDER AMERICAN POPULATIONS: Our results indicate that marital status may be more important than educational levels for understanding the health care behaviors of Chamorro, Filipina, and other Asian and Pacific Island women on Guam. KEY WORDS: Chamorro, Filipino, prenatal visitations, marital status, parental status.