Candida auris prevalence, risk factors and outcomes among acute inpatient physical rehabilitation patients

Abstract

Background: Candida auris (C. auris) is multi-drug resistant fungus that is known to cause serious and sometimes fatal infections. The organism also persistently colonizes hospital environments and multiple body sites of patients. The high transmissibility of C. auris, contributes to prolonged outbreaks in healthcare settings, which are challenging to manage, as there is uncertainty on how to best stop the spread of C. auris, identify C. auris, and treat C. auris colonization and infection.Objective: To identify risk factors for C. auris colonization and infection in patients undergoing rehabilitation; these results will inform future surveillance and screening programs targeted towards patients at risk for C. auris colonization and infection. Design: Retrospective analysis of risk factors associated with C. auris infection or colonization. Setting: Acute rehabilitation facility (ARF) affiliated with an academic medical center. Participants: Patients receiving care in an ARF from October 1, 2019 to January 31, 2020.Methods: Risk factors, including presence of immunodeficiency, care location, presence of a feeding tube, tracheostomy, mechanical ventilation, presence of a central line, history of other multi-drug resistant organisms (MDROs), and the presence of non-intact skin, wounds, and pressure injuries were reviewed retrospectively via the patients electronic medical record (EMR). The main outcome measure was the presence of a C. auris laboratory test result indicating infection or colonization. Statistical Analysis: We used descriptive statistics to describe the study population and the frequency of study outcomes. Odds ratios were performed to examine statistically significant differences. All the analyses were done using Microsoft Excel.Results: Of the 205 eligible ARF patients,11 (5.37%) patients were positive and 194 (94.63%) patients were negative for C. auris lab result. The prevalence of positive C. auris lab culture was 5.37 patients per 100 patients tested C. auris colonization or infection during the study period. Patients with a prior history of infection or colonization of other MDROs were more likely to be at risk for C. auris colonization or infection, OR=6.55 (95% CI 1.38-31.13). However, there was no significant association between C. auris infection or colonization and presence of immunodeficiency, care location, presence of feeding tube, tracheostomy, mechanical ventilation, or central line, and the presence of non-intact skin, wounds, and pressure injuries.Discussion: Among patients in an ARF, prior history of colonization or infection with other MDROs was associated with a significantly increased risk of a positive C. auris lab result. Other risk factors studied also had increased odds ratio for positive C. auris, however the relationship was not statistically significant. Further research, incorporating a larger sample and timeframe is needed to overcome the current studys limited power to investigate the association between C. auris and the other exposures or clinical factors. These results may help identify patients at risk for C. auris colonization and target patients for surveillance.

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