First Hospital Outbreak of the Globally Emerging in a European Hospital

Overview

Journal Antimicrob Resist Infect Control

Publisher Biomed Central

Specialty Infectious Diseases

Date 2016 Oct 26

PMID 27777756

Citations 318

Authors

Silke Schelenz

Ferry Hagen

Johanna L Rhodes

Alireza Abdolrasouli

Anuradha Chowdhary

Anne Hall

Lisa Ryan

Joanne Shackleton

Richard Trimlett

Jacques F Meis

Darius Armstrong-James

Matthew C Fisher

Affiliations

Soon will be listed here.

Abstract

Background: is a globally emerging multidrug resistant fungal pathogen causing nosocomial transmission. We report an ongoing outbreak of in a London cardio-thoracic center between April 2015 and July 2016. This is the first report of in Europe and the largest outbreak so far. We describe the identification, investigation and implementation of control measures.

Methods: Data on case demographics, environmental screening, implementation of infection prevention/control measures, and antifungal susceptibility of patient isolates were prospectively recorded then analysed retrospectively. Speciation of is was performed by MALDI-TOF and typing of outbreak isolates performed by amplified fragment length polymorphism (AFLP).

Results: This report describes an ongoing outbreak of 50 cases over the first 16 month (April 2015 to July 2016) within a single Hospital Trust in London. A total of 44 % ( = 22/50) patients developed possible or proven infection with a candidaemia rate of 18 % ( = 9/50). Environmental sampling showed persistent presence of the yeast around bed space areas. Implementation of strict infection and prevention control measures included: isolation of cases and their contacts, wearing of personal protective clothing by health care workers, screening of patients on affected wards, skin decontamination with chlorhexidine, environmental cleaning with chorine based reagents and hydrogen peroxide vapour. Genotyping with AFLP demonstrated that isolates from the same geographic region clustered.

Conclusion: This ongoing outbreak with genotypically closely related highlights the importance of appropriate species identification and rapid detection of cases in order to contain hospital acquired transmission.

Citing Articles

Virulence profile of pathogenic yeasts from snakes: Alternative ways for antifungal strategies.

Ugochukwu I, Mendoza-Roldan J, Miglianti M, Palazzo N, Odigie A, Otranto D PLoS One. 2025; 20(3):e0318703.

PMID: 40072936 PMC: 11902152. DOI: 10.1371/journal.pone.0318703.

Candida auris Outbreak and Epidemiologic Response in Burn Intensive Care Unit, Illinois, USA, 2021-2023.

Barbian H, Lie L, Kittner A, Harrington A, Carson J, Frias M Emerg Infect Dis. 2025; 31(3):438-447.

PMID: 40023787 PMC: 11878305. DOI: 10.3201/eid3103.241195.

The emerging fungal pathogen induces IFNγ to colonize mammalian hair follicles.

Merrill E, Prudent V, Moghadam P, Rodriguez A, Hurabielle C, Wells E bioRxiv. 2025; .

PMID: 39868197 PMC: 11760791. DOI: 10.1101/2025.01.15.632653.

Interactions of the emerging fungus with reveal phenotypic changes with direct implications on the response to stress and virulence.

Valente M, Martins Alcantara L, Cintra D, Mendoza S, Medeiros E, Gomes K Microbiol Spectr. 2024; 13(2):e0174624.

PMID: 39688412 PMC: 11792492. DOI: 10.1128/spectrum.01746-24.

: Epidemiology and Antifungal Strategy.

Eix E, Nett J Annu Rev Med. 2024; 76(1):57-67.

PMID: 39656947 PMC: 11808652. DOI: 10.1146/annurev-med-061523-021233.

References

Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H . Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol. 2009; 53(1):41-4. DOI: 10.1111/j.1348-0421.2008.00083.x. View

Kim M, Shin J, Sung H, Lee K, Kim E, Ryoo N . Candida haemulonii and closely related species at 5 university hospitals in Korea: identification, antifungal susceptibility, and clinical features. Clin Infect Dis. 2009; 48(6):e57-61. DOI: 10.1086/597108. View

Lee W, Shin J, Uh Y, Kang M, Kim S, Park K . First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol. 2011; 49(9):3139-42. PMC: 3165631. DOI: 10.1128/JCM.00319-11. View

Chowdhary A, Sharma C, Duggal S, Agarwal K, Prakash A, Kumar Singh P . New clonal strain of Candida auris, Delhi, India. Emerg Infect Dis. 2013; 19(10):1670-3. PMC: 3810747. DOI: 10.3201/eid1910.130393. View

Chowdhary A, Anil Kumar V, Sharma C, Prakash A, Agarwal K, Babu R . Multidrug-resistant endemic clonal strain of Candida auris in India. Eur J Clin Microbiol Infect Dis. 2013; 33(6):919-26. DOI: 10.1007/s10096-013-2027-1. View

Magobo R, Corcoran C, Seetharam S, Govender N . Candida auris-associated candidemia, South Africa. Emerg Infect Dis. 2014; 20(7):1250-1. PMC: 4073876. DOI: 10.3201/eid2007.131765. View

Chakrabarti A, Sood P, Rudramurthy S, Chen S, Kaur H, Capoor M . Incidence, characteristics and outcome of ICU-acquired candidemia in India. Intensive Care Med. 2014; 41(2):285-95. DOI: 10.1007/s00134-014-3603-2. View

Schelenz S, Barnes R, Barton R, Cleverley J, Lucas S, Kibbler C . British Society for Medical Mycology best practice recommendations for the diagnosis of serious fungal diseases. Lancet Infect Dis. 2015; 15(4):461-74. DOI: 10.1016/S1473-3099(15)70006-X. View

Kathuria S, Singh P, Sharma C, Prakash A, Masih A, Kumar A . Multidrug-Resistant Candida auris Misidentified as Candida haemulonii: Characterization by Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry and DNA Sequencing and Its Antifungal Susceptibility Profile Variability by Vitek.... J Clin Microbiol. 2015; 53(6):1823-30. PMC: 4432077. DOI: 10.1128/JCM.00367-15. View

10.

Prakash A, Sharma C, Singh A, Kumar Singh P, Kumar A, Hagen F . Evidence of genotypic diversity among Candida auris isolates by multilocus sequence typing, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and amplified fragment length polymorphism. Clin Microbiol Infect. 2015; 22(3):277.e1-9. DOI: 10.1016/j.cmi.2015.10.022. View

11.

Septimus E, Schweizer M . Decolonization in Prevention of Health Care-Associated Infections. Clin Microbiol Rev. 2016; 29(2):201-22. PMC: 4786886. DOI: 10.1128/CMR.00049-15. View

12.

Boyce J . Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrob Resist Infect Control. 2016; 5:10. PMC: 4827199. DOI: 10.1186/s13756-016-0111-x. View

13.

Girard V, Mailler S, Chetry M, Vidal C, Durand G, van Belkum A . Identification and typing of the emerging pathogen Candida auris by matrix-assisted laser desorption ionisation time of flight mass spectrometry. Mycoses. 2016; 59(8):535-8. DOI: 10.1111/myc.12519. View

14.

Calvo B, Melo A, Perozo-Mena A, Hernandez M, Francisco E, Hagen F . First report of Candida auris in America: Clinical and microbiological aspects of 18 episodes of candidemia. J Infect. 2016; 73(4):369-74. DOI: 10.1016/j.jinf.2016.07.008. View

15.

Sharma C, Kumar N, Pandey R, Meis J, Chowdhary A . Whole genome sequencing of emerging multidrug resistant Candida auris isolates in India demonstrates low genetic variation. New Microbes New Infect. 2016; 13:77-82. PMC: 5006800. DOI: 10.1016/j.nmni.2016.07.003. View

16.

Chowdhary A, Voss A, Meis J . Multidrug-resistant Candida auris: 'new kid on the block' in hospital-associated infections?. J Hosp Infect. 2016; 94(3):209-212. DOI: 10.1016/j.jhin.2016.08.004. View

17.

Lockhart S, Etienne K, Vallabhaneni S, Farooqi J, Chowdhary A, Govender N . Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses. Clin Infect Dis. 2016; 64(2):134-140. PMC: 5215215. DOI: 10.1093/cid/ciw691. View

18.

Vazquez J, Dembry L, Sanchez V, Vazquez M, Sobel J, Dmuchowski C . Nosocomial Candida glabrata colonization: an epidemiologic study. J Clin Microbiol. 1998; 36(2):421-6. PMC: 104553. DOI: 10.1128/JCM.36.2.421-426.1998. View