Candida auris

Cause: Candida auris is an emerging, often multidrug resistant, yeast first identified in Japan in 2009. It can cause invasive healthcare-associated infections with high mortality.

Illness and treatment: Healthy people usually do not get infections due to C. auris. Common infections associated with C. auris include blood stream and wound. Mortality associated with C. auris infections is estimated to be 30-60% however, many of these cases had other serious illnesses which may have caused or contributed to their deaths. C. auris may also colonize the skin and other body sites. Both infected and colonized patients can transmit the organism to others. For treatment guidance, consultation with an infectious disease specialist is highly recommended. CDC does not recommend treatment of C. auris identified from non-invasive sites (such as respiratory tract, urine, and skin) when there is no evidence of infection.

Sources: The most common sources for colonization or infection with C. auris are from health care worker's hands and other contaminated objects in the healthcare environment.

Additional Risks: In the United States, C. auris has been predominantly identified among patients with extensive exposure to ventilator units at skilled nursing facilities and long-term acute care hospitals, and those who have received healthcare in countries with extensive C. auris transmission.

Prevention: The best way to prevent colonization and infections with C. auris is through strict infection control precautions in healthcare settings including hand washing; placing patients infected with C. auris on "contact precautions" (private room, caring for patient with gloves and gown); minimizing the use of invasive devices such as central venous lines, urinary catheters and ventilators; and using antibiotics only when necessary and for the minimum time.

Recent Washington trends: As of December 2022, no C. auris cases have been reported in Washington. Neighboring states, Oregon and British Columbia, in addition to other more distant states such as California, Nevada, New York, New Jersey, and Illinois, have experienced healthcare outbreaks.

Purpose of Reporting and Surveillance

To increase awareness of Candida auris by public health and healthcare professionals.
To promote appropriate infection control interventions to prevent transmission of Candida auris within and between healthcare facilities, and between healthcare facilities and the community.
To rapidly identify Candida auris and prevent or eliminate sources or sites of ongoing transmission within Washington.
To better characterize the epidemiology of Candida auris infections in Washington to guide response.

Required Reporting

1. Health care providers and Health care facilities: notifiable to the local health jurisdiction within 24 hours.

2. Laboratories: lab report to the local health jurisdiction (LHJ) within 24 hours; submission required to PHL – isolate or if no isolate specimen associated with positive result, within 2 business days.

Positive result by any method including, but not limited to, culture, nucleic acid detection (NAT or NAAT), or whole genome sequencing;
Isolates should be accompanied by a Public Health Laboratories (PHL) Antibiotic Resistance Lab Network (ARLN) Requisition Form. See ARLN Test Menu and Specimen Collection and Submission Instructions for details on isolate submission.

3. Local health jurisdictions: notifiable to Washington State Department of Health (DOH) Office of Communicable Disease Epidemiology (CDE) within 7 days of case investigation completion or summary of information required within 21 days.

Reporting and submission of certain other Candida species is strongly encouraged but not mandated by law. Some yeast identification assays, including VITEK 2 YST, API 20C, BD Phoenix yeast identification system, and MicroScan, can misidentify Candida auris as other Candida species such as Candida haemulonii, Candida duobushaemulonii, Rhodotorula glutinis, Candida intermedia, Candida sake, Saccharomyces kluyveri, Candida catenulate, Candida famata, Candida guilliermondii, Candida lusitaniae, and Candida parapsilosis. Laboratories should know the limitations of their yeast identification system by reviewing Identification of Candida auris to avoid mistakenly identifying C. auris as another fungal species and report these cases and submit these isolates to PHL for confirmatory testing. Other labs may serve as Candida sentinel labs and submit to PHL all Candida species except albicans. For information about sentinel labs, please contact the Washington Antibiotic Resistance Lab Network at ARLN@doh.wa.gov. Any C. auris identified at PHL will be reported immediately to the LHJ and a public health investigation started.