Candida auris and Resistant Bacteria at a Chicago Children's Hospital, 2019

Candida auris is an emerging fungus that is often resistant to drugs, can be hard to identify, and has caused outbreaks in health care settings. Chicago identified its first case in May 2016. More have followed, especially in high-acuity post-acute care facilities, and spread within such facilities has been documented across the country. Chicago has run point prevalence surveys to track it since August 2016.

Chicago's long-term acute-care hospitals have also had high rates of carbapenemase-producing organisms (CPOs) since 2010. Both C. auris and CPOs can colonize people for long periods and, because they resist drugs, can cause invasive infections that are hard to treat. People can carry both at once. Adults in long-term acute care face higher risk because of serious illness, long stays, medical devices left in the body and frequent contact with health care workers. As of June 2019, the median colonization rates in Chicago's four long-term acute-care hospitals were 31% for C. auris and 24% for CPOs.

Little was known about children. C. auris colonization had never been described in Chicago's pediatric patients, and data on CPOs in children outside intensive care units were limited.

The survey

In August 2019, the Chicago Department of Public Health surveyed a 49-bed pediatric hospital that provides long-term transitional care for children leaving pediatric intensive care. Every patient was included unless a parent's consent could not be obtained.

• Staff recorded each patient's medical devices and length of stay.
• Swabs from the armpits and groin were tested for C. auris by real-time PCR and culture; rectal swabs were tested by real-time PCR for the carbapenemase genes blaKPC, blaNDM, blaVIM, blaOXA-48 and blaIMP, with culture attempted on positives. The Wisconsin State Laboratory of Hygiene did the testing.
• Patients were checked against the Illinois extensively drug-resistant organism (XDRO) registry for earlier reports.

Of the 29 children in the hospital that day, 25 (86%) were screened. Two rectal swabs were unsatisfactory and gave invalid CPO results.

The patients

The children's median age was 1.2 years, ranging from 26 days to 17.4 years. Most depended on medical devices:

• 26 (90%) had a gastrostomy tube;
• 24 (83%) had a tracheostomy;
• 20 (69%) needed a mechanical ventilator;
• three (10%) had a central venous catheter.

The median stay was 35 days.

Results

No child had an earlier report of C. auris or a CPO in the registry. No specimen was positive for C. auris. One child's specimen was positive for the blaOXA-48 gene, giving the facility a CPO prevalence of 3.4%, although no organism was grown from that specimen.

What it means

This was the first documented screening for C. auris in a pediatric transitional care hospital in the United States. Although adult facilities of similar acuity in the region had high rates, C. auris was not found and CPOs were rare here. The health department planned biannual assessments of the hospital. Because only one facility was studied, the authors call for similar surveys in other pediatric settings.

Sources

• McPherson TD, Walblay KA, Roop E, et al. Notes from the Field: Candida auris and Carbapenemase-Producing Organism Prevalence in a Pediatric Hospital Providing Long-Term Transitional Care — Chicago, Illinois, 2019. MMWR Morb Mortal Wkly Rep 69(34). https://www.cdc.gov/mmwr/volumes/69/wr/mm6934a5.htm
• CDC, Candida auris: https://www.cdc.gov/fungal/candida-auris/index.html