Claas Baier (Hannover / DE), Andreas Klos (Hannover / DE), Leonard Knegendorf (Hannover / DE), Ludwig Sedlacek (Hannover / DE), Stefan Ziesing (Hannover / DE), Thorben Dieck (Hannover / DE), Vincent März (Hannover / DE), Khaled Dastagir (Hannover / DE), Dirk Schlüter (Hannover / DE), Peter M. Vogt (Hannover / DE), Ella Ebadi (Hannover / DE)
Introduction
Candida auris (Ca) is an increasing infectious disease and infection prevention and control (IPC) challenge in recent years [1]. Its potential to spread in hospitals is feared. We present the IPC management of a Ca positive patient in a burn intensive care unit (BICU).
Materials
We describe the IPC measures which were inspired by existing recommendations [2]. We also highlight open aspects of IPC management that have arisen for us in practice.
Results
The pre-hospitalised patient was transferred from Ukraine and admitted to the BICU. In accordance with internal IPC standards, the patient was pre-emptively isolated and a screening for multidrug-resistant bacteria took place. This revealed several carbapenem-resistant Gram-negative bacteria, VRE and MRSA. The patient was cared for under strict IPC standards including PPE for staff and 1:1 care whenever possible. On day 13 of the stay, Ca was detected in a wound material. Immediately, the patient and all other patients on the BICU were screened for Ca (nose/throat, axillae, groin, rectal, respiratory secretions, catheter urine, wounds; initially with regular malt extract agar). CHROMagar™ Candida Plus was introduced ad hoc in the microbiological laboratory. The ward contact patients were screened every 3 days initially and then once a week. Ward disinfection was enhanced and repeated on-site audits took place. After the Ca patient was not more on the ward long term follow-up screening was implemented.
Summary
For the first time, a patient with Ca was treated in our BICU. Due to close co-operation between the clinic, IPC and microbiology, comprehensive screening was quickly established. To date, no transmission has been detected, to which the pre-emptive isolation and the high IPC standards of the BICU have contributed. An important aspect is to clarify which groups should be screened for Ca on admission.
References
[1] Aldejohann AM et al. Rise in Candida Auris Cases and First Nosocomial Transmissions in Germany. doi: 10.3238/arztebl.m2023.0047
[2] Aldejohann AM et al. Expert recommendations for prevention and management of Candida auris transmission. doi: 10.1111/myc.13445