Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois, USA.
Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, USA.
Clin Infect Dis. 2020 Dec 31;71(11):e718-e725. doi: 10.1093/cid/ciaa435.
Since the identification of the first 2 Candida auris cases in Chicago, Illinois, in 2016, ongoing spread has been documented in the Chicago area. We describe C. auris emergence in high-acuity, long-term healthcare facilities and present a case study of public health response to C. auris and carbapenemase-producing organisms (CPOs) at one ventilator-capable skilled nursing facility (vSNF-A).
We performed point prevalence surveys (PPSs) to identify patients colonized with C. auris and infection-control (IC) assessments and provided ongoing support for IC improvements in Illinois acute- and long-term care facilities during August 2016-December 2018. During 2018, we initiated a focused effort at vSNF-A and conducted 7 C. auris PPSs; during 4 PPSs, we also performed CPO screening and environmental sampling.
During August 2016-December 2018 in Illinois, 490 individuals were found to be colonized or infected with C. auris. PPSs identified the highest prevalence of C. auris colonization in vSNF settings (prevalence, 23-71%). IC assessments in multiple vSNFs identified common challenges in core IC practices. Repeat PPSs at vSNF-A in 2018 identified increasing C. auris prevalence from 43% to 71%. Most residents screened during multiple PPSs remained persistently colonized with C. auris. Among 191 environmental samples collected, 39% were positive for C. auris, including samples from bedrails, windowsills, and shared patient-care items.
High burden in vSNFs along with persistent colonization of residents and environmental contamination point to the need for prioritizing IC interventions to control the spread of C. auris and CPOs.
自 2016 年伊利诺伊州芝加哥首次发现 2 例耳念珠菌病例以来，该菌在芝加哥地区持续传播。我们描述了耳念珠菌在高风险、长期医疗保健机构中的出现，并报告了一例针对一家具备通气能力的长期护理机构（vSNF-A）的耳念珠菌和产碳青霉烯酶的生物体（CPO）的公共卫生应对案例研究。
我们进行了点患病率调查（PPS）以确定耳念珠菌定植的患者，并对伊利诺伊州的急性和长期护理机构进行了感染控制（IC）评估，并为其 IC 改进提供了持续支持，时间为 2016 年 8 月至 2018 年 12 月。2018 年，我们在 vSNF-A 开展了一项重点工作，并进行了 7 次耳念珠菌 PPS；在 4 次 PPS 中，我们还进行了 CPO 筛查和环境采样。
在伊利诺伊州，2016 年 8 月至 2018 年 12 月期间，发现 490 人感染或定植了耳念珠菌。PPS 确定了 vSNF 中耳念珠菌定植的最高流行率（流行率为 23-71%）。在多个 vSNF 进行的 IC 评估确定了核心 IC 实践中常见的挑战。2018 年 vSNF-A 的重复 PPS 发现，耳念珠菌的流行率从 43%增加到 71%。在多次 PPS 中筛查的大多数居民仍然持续定植耳念珠菌。在收集的 191 个环境样本中，39%的样本呈耳念珠菌阳性，包括床栏、窗台和共享的患者护理物品。
vSNF 中的高负担，以及居民的持续定植和环境污染，表明需要优先进行 IC 干预，以控制耳念珠菌和 CPO 的传播。
