Department of General Medicine and Division of Infectious Diseases, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
BMC Infect Dis. 2021 May 6;21(1):425. doi: 10.1186/s12879-021-06131-6.
Candida auris infections are an emerging global threat with poor clinical outcome, high mortality rate, high transmission rate and outbreak potential. The objective of this work is to describe a multidisciplinary approach towards the investigation and containment of a Candida auris outbreak and the preventive measures adopted in a resource limited setting.
This outbreak investigational study was conducted at a 1300-bedded tertiary care academic hospital in South India. The study included 15 adult inpatients with laboratory confirmed Candida auris isolates. The outbreak cluster was identified in adult patients admitted from September 2017 to 2019. The system response consisted of a critical alert system for laboratory confirmed Candida auris infection and multidisciplinary 'Candida auris care team' for patient management. The team implemented stringent Infection Prevention and Control (IPC) measures including patient cohorting, standardized therapy and decolonization, staff training, prospective surveillance and introduction of Candida auris specific care bundle.
Two outbreak clusters were identified; first cluster occurring between October and November 2017 and the second cluster in May 2018. The cohorts consisted of 7 and 8 Candida auris positive patients in the first and second waves of the outbreak respectively with a total survival rate of 93% (14/15). Deployment of containment measures led to gradual decline in the incidence of adult Candida auris positive cases and prevented further cluster formation.
The sustained implementation of guideline and evidence-based IPC measures and training of healthcare workers for improving awareness on systematically following standardized protocols of Candida auris related IPC practices successfully contained Candida auris outbreaks at our hospital. This demonstrates the feasibility of establishing a multidisciplinary model and bundling of practices for preventing Candida auris outbreaks in a Low- and Middle-income country.
耳念珠菌感染是一种新兴的全球威胁，具有临床预后差、死亡率高、传播率高和暴发潜力大的特点。本研究旨在描述一种多学科方法，用于调查和控制耳念珠菌的暴发，并描述在资源有限的情况下采取的预防措施。
本研究是在印度南部一家拥有 1300 张床位的三级保健学术医院进行的。研究包括 15 例成人住院患者，经实验室确认感染耳念珠菌。暴发集群在 2017 年 9 月至 2019 年期间入院的成年患者中发现。该系统应对措施包括实验室确认耳念珠菌感染的紧急警报系统和多学科“耳念珠菌护理团队”来管理患者。该团队实施了严格的感染预防和控制（IPC）措施，包括患者分组、标准化治疗和去定植、员工培训、前瞻性监测以及引入耳念珠菌特定护理包。
共发现两个暴发集群，第一个集群发生在 2017 年 10 月至 11 月，第二个集群发生在 2018 年 5 月。第一波暴发中有 7 例，第二波暴发中有 8 例耳念珠菌阳性患者，总生存率为 93%（14/15）。实施控制措施后，成人耳念珠菌阳性病例的发病率逐渐下降，且未再发生集群性感染。
持续实施指南和基于证据的 IPC 措施，并对卫生保健工作者进行培训，以提高他们对系统遵循耳念珠菌相关 IPC 实践标准化方案的意识，成功地遏制了我们医院的耳念珠菌暴发。这表明在中低收入国家建立多学科模式和实践捆绑包以预防耳念珠菌暴发是可行的。
