RAPID EMERGENCE OF CANDIDA AURIS IN NORTH ITALY, 2019 TO JULY 2022

Abstract

Intro: Candida auris represents a serious global health threat. Cases have been reported from over 40 countries in six continents. In Italy, the 1st case was detected in July 2019, never reported to the Ministry of Health (MoH); 2 cases were notified on January and July 2020; 277 cases occurred between November 2020 and October 2021, notified on November 2021 following specific ministerial request; 32 cases were notified November 2021-July 2022. Here we describe the outbreak to raise awareness on this growing threat. Methods: Cases were notified by the local facilities to regional health authorities and/or the MoH. We defined a confirmed case as a subject infected/colonized by C. auris isolated from any type of sample from sterile/non- sterile site. We performed descriptive analysis by R software (version 4.1.1). Findings: In 4 regions, 312 cases (66% males, median age 59, range 0-76 years) were detected in 12 healthcare facilities, including 34 (11%) deaths. The minority of patients (22%) were colonised. One had history of travel abroad. Over two third were from reanimation and intensive care units. All the environmental samples tested negative. Weekly screening of contacts and instruction of cases were performed at the facilities. Infection prevention and control (IPC) measures were applied locally. The MoH nominated a National Reference Laboratory. Two messages were posted through the Epidemic Intelligence Information System in 2021. On February 2022, rapid risk assessment declared the risk for further spread high within Italy and low to other countries. Conclusion: Awareness is crucial to identify C. auris colonisation/infection. Appropriate microbiological capacity and ability for patient isolation, prompt case information, strict adherence to IPC measures, periodic screening of contacts, chlorine-based environmental cleaning and reprocessing of medical devices or dedicated equipment, strengthened microbiological and epidemiological surveillance, and prompt notification at both regional and national level are fundamental to stop C. auris spread.