ADS 25 - A Review of an Expanded Candida Auris Screening Protocol

Background: Candida auris is an emerging fungal pathogen associated with healthcare-associated outbreaks.
It is often multidrug resistant and has high mortality and morbidity. Early detection and
isolation of colonized patients is essential to prevent its spread. This study aimed to determine
the utility of expanding a C. auris screening protocol to include all transfers from outside
healthcare facilities and all admissions to intensive care units (ICU).

Methods: An expanded 3-month C. auris screening protocol was initiated in June 2022 within a three
hospital regional system. All transfers from skilled nursing facilities (SNFs), outside hospitals
(OSH), and long term acute care facilities (LTACs) and as well as all ICU admissions were
screened for C. auris. Pediatric and previous positive screen patients were excluded from this
protocol. Cultures were obtained using a single standard double tipped culture swab of the
bilateral axilla and groin. Percent compliance to the new protocol and percent positivity was
calculated to determine utility of screening.

Results: 774 of 1,575 (49.1%) of ICU admissions were screened. 16 (2.1%) ICU patients screening
positive. 14 of 16 (87.5%) were identified as SNFs/LTACs/OSHs admissions. Of the 16 positive
cases, 8 had a prior history of C. auris, so we only detected new/unknown C. auris cases in 1%
of those screened. Non-ICU screening compliance could not be calculated. Difficulty in
recognizing which patients were SNF/LTAC/OSH transfers was the major impediment to better
adherence to the screening protocol for non-ICU admissions.

Conclusions: C. auris prevalence remains very low in the population served by this 3 hospital system, making
continuous screening ineffective. Our program confirmed that targeted screening of all
SNF/LTACs/OSHs admissions would yield the most benefit, however significant challenges in
identifying these patients, undermined the screening program. Implementation of an effective
C. auris screening program requires the effective flagging of patients at higher risk for C. auris.