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Rapid Assessment and Containment of Candida auris Transmission in Postacute Care Settings-Orange County, California, 2019.
Karmarkar, Ellora N; O'Donnell, Kathleen; Prestel, Christopher; Forsberg, Kaitlin; Gade, Lalitha; Jain, Seema; Schan, Douglas; Chow, Nancy; McDermott, Darby; Rossow, John; Toda, Mitsuru; Ruiz, Ryan; Hun, Sopheay; Dale, Jennifer L; Gross, Annastasia; Maruca, Tyler; Glowicz, Janet; Brooks, Richard; Bagheri, Hosniyeh; Nelson, Teresa; Gualandi, Nicole; Khwaja, Zenith; Horwich-Scholefield, Sam; Jacobs, Josh; Cheung, Michele; Walters, Maroya; Jacobs-Slifka, Kara; Stone, Nimalie D; Mikhail, Lydia; Chaturvedi, Sudha; Klein, Liore; Vagnone, Paula Snippes; Schneider, Emily; Berkow, Elizabeth L; Jackson, Brendan R; Vallabhaneni, Snigdha; Zahn, Matthew; Epson, Erin.
Afiliação
  • Karmarkar EN; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, and the California Department of Public Health, Richmond, California (E.N.K.).
  • O'Donnell K; Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.).
  • Prestel C; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.).
  • Forsberg K; Centers for Disease Control and Prevention and IHRC, Atlanta, Georgia (K.F.).
  • Gade L; Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.).
  • Jain S; California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.).
  • Schan D; Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.).
  • Chow N; Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.).
  • McDermott D; Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.).
  • Rossow J; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.).
  • Toda M; Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.).
  • Ruiz R; Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.).
  • Hun S; Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.).
  • Dale JL; Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.).
  • Gross A; Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.).
  • Maruca T; Maryland Department of Health Laboratories Administration, Baltimore, Maryland (T.M., L.K.).
  • Glowicz J; Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.).
  • Brooks R; Centers for Disease Control and Prevention, Atlanta, Georgia, and the Maryland Department of Health, Infectious Disease Epidemiology and Outbreak Response Bureau, Baltimore, Maryland (R.B.).
  • Bagheri H; California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.).
  • Nelson T; California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.).
  • Gualandi N; Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.).
  • Khwaja Z; California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.).
  • Horwich-Scholefield S; California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.).
  • Jacobs J; Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.).
  • Cheung M; Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.).
  • Walters M; Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.).
  • Jacobs-Slifka K; Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.).
  • Stone ND; Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.).
  • Mikhail L; Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.).
  • Chaturvedi S; New York State Department of Health, Albany, New York (S.C.).
  • Klein L; Maryland Department of Health Laboratories Administration, Baltimore, Maryland (T.M., L.K.).
  • Vagnone PS; Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.).
  • Schneider E; Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.).
  • Berkow EL; Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.).
  • Jackson BR; Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.).
  • Vallabhaneni S; Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.).
  • Zahn M; Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.).
  • Epson E; California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.).
Ann Intern Med ; 174(11): 1554-1562, 2021 11.
Article em En | MEDLINE | ID: mdl-34487450
ABSTRACT

BACKGROUND:

Candida auris, a multidrug-resistant yeast, can spread rapidly in ventilator-capable skilled-nursing facilities (vSNFs) and long-term acute care hospitals (LTACHs). In 2018, a laboratory serving LTACHs in southern California began identifying species of Candida that were detected in urine specimens to enhance surveillance of C auris, and C auris was identified in February 2019 in a patient in an Orange County (OC), California, LTACH. Further investigation identified C auris at 3 associated facilities.

OBJECTIVE:

To assess the prevalence of C auris and infection prevention and control (IPC) practices in LTACHs and vSNFs in OC.

DESIGN:

Point prevalence surveys (PPSs), postdischarge testing for C auris detection, and assessments of IPC were done from March to October 2019.

SETTING:

All LTACHs (n = 3) and vSNFs (n = 14) serving adult patients in OC.

PARTICIPANTS:

Current or recent patients in LTACHs and vSNFs in OC. INTERVENTION In facilities where C auris was detected, PPSs were repeated every 2 weeks. Ongoing IPC support was provided. MEASUREMENTS Antifungal susceptibility testing and whole-genome sequencing to assess isolate relatedness.

RESULTS:

Initial PPSs at 17 facilities identified 44 additional patients with C auris in 3 (100%) LTACHs and 6 (43%) vSNFs, with the first bloodstream infection reported in May 2019. By October 2019, a total of 182 patients with C auris were identified by serial PPSs and discharge testing. Of 81 isolates that were sequenced, all were clade III and highly related. Assessments of IPC identified gaps in hand hygiene, transmission-based precautions, and environmental cleaning. The outbreak was contained to 2 facilities by October 2019.

LIMITATION:

Acute care hospitals were not assessed, and IPC improvements over time could not be rigorously evaluated.

CONCLUSION:

Enhanced laboratory surveillance and prompt investigation with IPC support enabled swift identification and containment of C auris. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Candidíase / Cuidados Semi-Intensivos País/Região como assunto: America do norte Idioma: En Ano de publicação: 2021 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Candidíase / Cuidados Semi-Intensivos País/Região como assunto: America do norte Idioma: En Ano de publicação: 2021 Tipo de documento: Article