2039. New York State 2016-2018: Progression from Candida auris Colonization to Bloodstream Infection
Session: Poster Abstract Session: Diagnostics: Mycology
Saturday, October 6, 2018
Room: S Poster Hall
Background: New York State (NYS) is experiencing a continuing outbreak of Candida auris (C. auris), first identified in 2016. Patients who are colonized asymptomatically with C. auris can progress to bloodstream infection (BSI).

Methods: Colonized patients with positive nares or axilla/groin C. auris cultures were followed prospectively. Laboratories, hospitals and skilled nursing facilities reported C. auris clinical infections to the NYS Department of Health. Patient demographics, clinical history, hospital admission, procedures, and outcomes data were obtained using a standardized case report form. Patient days were determined from date of first positive colonization to date of first positive clinical isolate, death, or 3/30/2018, whichever was first.

Results: Between 9/28/2016 and 3/30/2018, 187 C. auris colonized patients were identified. Of these, seven progressed to BSI during at least 24,781 patient days of follow up (median: 98 patient days, range 0-548 days.) The median time from date of first colonization to date of BSI was 86 days (range 3-310 days). The median patient age at time of colonization was 71 years (range 57-89 years). Between colonization and BSI, patients had a median of five admissions in health care facilities (range 1 – 12). All patients had central neurologic disease, gastrostomy tubes, chronic wounds, and vascular lines at time of BSI. All patients had a positive culture for one or more other multi-drug resistant organism within 90 days of a positive C. auris culture, and all received antibiotics in the 30 days before BSI. Six (86%) patients received mechanical ventilation and had tracheostomies. Five (71%) patients had diabetes. Four (57%) had vascular lines replaced in the 30 days before BSI onset. Two (29%) cases had gastrostomy tube replacement between colonization and BSI. One patient died a week after C. auris BSI; a second died four months later.

Conclusion: In NYS, 4% of C. auris colonized patients developed BSI, a rate of 0.3 BSI per 1,000 patient days. BSI patients have portals of entry such as indwelling medical devices and wounds. Neurologic disease and diabetes may be risk factors for BSI. Meticulous aseptic technique for invasive procedures, device and wound care may help prevent C. auris BSI in colonized patients.

Karen Southwick, MD, MSc1, Eleanor H. Adams, MD, MPH1, Jane Greenko, RN, MPH, CIC2, Belinda Ostrowsky, MD, MPH3, Rafael Fernandez, MPH4, Rutvik Patel, MSW1, Monica Quinn, RN, MS, CIC5, Snigdha Vallabhaneni, MD, MPH6, Ronald Jean Denis, BS1, Richard Erazo, BS1, Sudha Chaturvedi, PhD7, Valerie B. Haley, PhD5, Lynn Leach, MS7, Yan Chun Zhu, MS7, Rosalie Giardina, BS8, Emily C. Lutterloh, MD, MPH5 and Debra S. Blog, MD, MPH9, (1)Healthcare Epidemiology & Infection Control, New York State Department of Health, New Rochelle, NY, (2)Healthcare Epidemiology & Infection Control, New York State Department of Health, Central Islip, NY, (3)Dhqp, Centers for Disease Control and Prevention, NY, NY, (4)Healthcare Epidemiology & Infection Control, New York State Department of Health, New York, NY, (5)Bureau of Healthcare-Associated Infections, New York State Department of Health, Albany, NY, (6)Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (7)Wadsworth Center, New York State Department of Health, Albany, NY, (8)New York State Department of Health, Albany, NY, (9)Division of Epidemiology, New York State Department of Health, Albany, NY

Disclosures:

K. Southwick, None

E. H. Adams, None

J. Greenko, None

B. Ostrowsky, None

R. Fernandez, None

R. Patel, None

M. Quinn, None

S. Vallabhaneni, None

R. Jean Denis, None

R. Erazo, None

S. Chaturvedi, None

V. B. Haley, None

L. Leach, None

Y. C. Zhu, None

R. Giardina, None

E. C. Lutterloh, None

D. S. Blog, None

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