1268. Transmissibility of Candida auris by Type of Inpatient Healthcare Facility
Session: Poster Abstract Session: Healthcare Epidemiology: Outbreaks
Friday, October 5, 2018
Room: S Poster Hall

Candida auris is a multidrug-resistant yeast causing outbreaks in healthcare settings. Stopping the spread of C. auris requires rapid identification of healthcare facilities at risk of higher transmission to help targeted implementation of infection control measures. We used data collected during public health investigations to quantify transmissibility of C. auris by type of healthcare facility.


In two states, 3,159 patient swabs were collected during 96 C. auris point prevalence surveys conducted at 36 inpatient healthcare facilities in November 2016 - April 2018. We estimated facility transmissibility and facility reproduction number (number infected by one index colonized patient per day, and per stay, respectively, at the facility) of C. auris based on estimated colonization pressure, a count of newly colonized patients between successive surveys at the same facility, and mean lengths of stay at facilities (estimated from CMS administrative data). The results were summarized by facility type: acute care hospital (ACH), long-term acute care hospital (LTACH) or ventilator unit at skilled nursing facility (VSNF), and were compared to previous estimates for transmissibility of carbapenem-resistant Enterobacteriaceae (CRE).


Swabs were collected from 13 ACHs, 12 LTACHs and 11 VSNFs. The C. auris facility reproduction number may exceed the critical value of 1 in both ACHs and VSNFs, and may exceed that for CRE in ACHs (Table).


Transmissibility of C. auris is comparable to that of CRE. The transmissibility within VSNFs emphasizes their potential role as amplifiers in the outbreak. Understanding transmissibility by facility type helps evaluate the potential impact of interventions in various settings.

Table: Transmissibility of C. auris by facility type

Facility type

C. auris transmissibility (per day) (median, IQR)

C. auris reproduction number (per stay)

(median, IQR)

CRE transmissibility1

(per day) (mean, 95% CI)

CRE reproduction number1


0.218 (0.215-0.221)

1.05 (1.04-1.07)

0.104 (0.079-0.138)



0.035 (0.019-0.045)

0.73 (0.40-0.97)

0.042 (0.036-0.049)



0.019 (0.014-0.023)

1.05 (0.70-1.27)



1Previous estimates (Poster 429, SHEA 2018), for comparison

Prabasaj Paul, PhD, MPH1, Kaitlin Forsberg, MPH2, Snigdha Vallabhaneni, MD, MPH2, Shawn R Lockhart, PhD3, Anastasia P. Litvintseva, PhD2, Janna L. Kerins, VMD, MPH4, Angela S. Tang, MPH5, Olufemi Jegede, MPH6, Patricia M. Barrett, MSD7, Kathleen Ross, MPH7, Rachel Slayton, PhD, MPH1 and John A. Jernigan, MD, MS1, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (3)Centers for Disease Control and Prevention, Atlanta, GA, (4)Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, (5)Illinois Department of Public Health, Chicago, IL, (6)Infectious Diseases, Detroit Medical Center/ Wayne State University, Detroit, MI, (7)New Jersey Department of Health, Trenton, NJ


P. Paul, None

K. Forsberg, None

S. Vallabhaneni, None

S. R. Lockhart, None

A. P. Litvintseva, None

J. L. Kerins, None

A. S. Tang, None

O. Jegede, None

P. M. Barrett, None

K. Ross, None

R. Slayton, None

J. A. Jernigan, None

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