Enhancing infection control to prevent Candida auris in ICU patients: key insights from Saudi Arabia

Abstract Candida auris, a multidrug-resistant yeast, has recently been recognized as an important global health concern. Challenges in identification, treatment, and cleaning and disinfection have contributed to its spread within healthcare facilities and have been associated with outbreaks of invasive healthcare-associated infections worldwide. Objective: This study aimed to identify the clinical and epidemiological characteristics of C. auris cases, and to highlight the significance of strict infection control interventions for prevention of in-hospital C. auris transmission. Methods: We implemented infection control mitigation interventions including early identification, active screening, stringent infection control measures, patient skin hygiene, effective instrument and environmental disinfection. In addition, weekly screening and environmental cultures were implemented to detect potential sources of ongoing transmission. Results: This study investigated reported C. auris cases at KAMC between November 2020 and December 2021. During the study period, a total of 44 positive cultures were identified among 1,408 ICU admissions. Of these, 27.27% (12 cases) were infected and 72.72% (32 cases) were colonized. The average patient age was 56.58 years. The average hospital length of stay was 37 days and was significantly higher in the infection group. Following analysis of different risk factors, we concluded CRE colonization was associated with Candida auris infection, while ICU length of stay was not significant after adjustment. Hypertension, DM, COVID, ARDS and exposure to invasive devices such as FC, MV, CVC were common clinical factors for most of the studied C. auris patients. Discussion and conclusion: Implementation of infection control interventions, including unit-based screening, strict adherence to hand hygiene, contact precautions, environmental disinfection, and patient hygiene, was associated with a reduction in cases. Initiating a protocol of weekly screening caused an increase in the detection of colonization cases but was the only way to detect hidden transmission. No new cases were detected after two potential environmental sources were identified, targeted disinfection protocols were implemented, and twice-daily patient skin hygiene was reinforced. This was observed as C. auris infection/colonization cases dropped to zero in the final three months, suggesting successful containment of the outbreak during the study period.