Candida auris screening practices at healthcare facilities in the United States: A survey of the Emerging Infections Network

Abstract

Background: Candida auris, an emerging fungal pathogen, is frequently drug resistant and spreads rapidly in healthcare facilities. Screening to identify patients colonized with C. auris can prevent further spread by prompting aggressive infection prevention and control measures. The CDC recommends C. auris screening based on local epidemiological conditions, patient characteristics, and facility-level risk factors; such screening might help facilities in higher burden areas to mitigate transmission and those in lower-burden areas to detect new introductions before spread begins. To describe US screening practices and challenges, we surveyed a network of infection disease practitioners, comparing responses by local C. auris case burdens. Methods: In August 2022, we emailed a survey about C. auris screening practices to ~3,000 members of the IDSA Emerging Infection Network. We describe survey results, stratifying findings by whether the healthcare facility was in a region where C. auris is frequently identified (tier 3 facility) or not frequently identified (tier 2 facility), based on CDC assessment using existing multidrug-resistant organism containment guidance (https://www.cdc.gov/hai/containment/guidelines.html). Results: We received 253 responses (tier 3 facilities: 119, tier 2 facilities: 134); overall, 37% performed screening. Tier 3 facilities more frequently performed screening than tier 2 facilities (59% vs 17%). Among facilities that performed screening, tier 3 facilities, compared with tier 2 facilities, more frequently screened patients on admission (84% vs 55%) and used an in-house laboratory for testing (68% vs 29%), most often with culture-based methods. Tier 2 facilities more frequently screened patients already admitted in the facility (eg, in response to cases or as part of point-prevalence surveys) compared with tier 3 facilities (59% vs 49%). Among facilities performing screening, 72% had identified ≥1 case in the previous year (tier 3 facilities, 85%; tier 2 facilities, 33%). Barriers to screening included limited laboratory capacity, long testing turnaround times, and the perception that screening was not useful. Conclusions: Most facilities surveyed did not perform C. auris screening. However, most facilities that performed screening, including those in regions of higher and lower C. auris burden, detected cases during the previous year. Admission screening, which might help detect new introductions before spread begins, was uncommon in facilities in lower-burden areas. Improving ease of C. auris screening through access to in-house laboratory testing with rapid turnaround times might increase the adoption of C. auris screening by facilities, thereby increasing detection and preventing spread.