Candida auris (C. auris)

What is Candida auris? 

Candida auris (C. auris) is an emerging fungus that can cause serious, hard-to-treat infections. It is difficult to treat because it can be resistant to the commonly used classes of antifungal medications. C. auris hard to identify, with symptoms being unnoticeable in those who already have a serious underlying illness or conditionsIdentifying C. auris with standard laboratory methods can also be challenging, which can lead to misidentification and improper care and treatment of infected patients. Unlike other multi-drug resistant organisms like Carbapenem Resistant Enterobacterales (CRE) and Methicillin-resistant Staphylococcus aureus (MRSA), C. auris can spread quickly in healthcare settings via person-to-person transmission or contact with contaminated equipment or surfaces and cause outbreaks. Proper infection prevention, diligent hand hygiene, and environmental cleaning can help reduce infections and outbreaks of C. auris within the healthcare facilities.  

Who is at risk? 

Those who have recently spent time in nursing homes and have lines and tubes that go into their body (such as breathing tubes, feeding tubes and central venous catheters), are at highest risk for C. auris infection. Other risk factors include recent surgery, diabetes, and broad-spectrum antimicrobial use. Infections have been found in patients of all ages, from preterm infants to the elderly.   

Colonization vs. Infection 

C. auris can sometimes be colonized or cause infection. Colonization is when a person is carrying C. auris somewhere in or on their body but does not have any symptoms or infection. Healthcare providers can perform a simple test to see the patient is carrying the fungus. It is still possible for someone with C. auris colonization to pass on the fungus to another person. Symptoms may not be apparent because of a patient’s underlying or current medical condition(s). Patients colonized with C. auris may develop an infection later if the pathogen has an opportunity to enter the body. In patients with a known colonization status, healthcare providers should take necessary steps to prevent infection. (Additional information regarding prevention and control is found below).  

Infection is when C. auris causes severe invasive disease. Symptoms can depend on which part of the body the yeast or fungus is affecting. If it is infection the bloodstream, symptoms may include fever and chills. An invasive C. auris infection can be fatal if affects the blood, heart, or brain. 

Transmission 

C. auris can spread through direct contact and is typically acquired in healthcare settings (hospitals and nursing homes). It can be passed on by hands of healthcare workers by direct contact or by contact with contaminated surfaces and equipment. Individuals may become infected with C. auris when the fungus is able to enter the body through contaminated medical equipment such as tubes, lines, or ventilators.  

Prevention 

To prevent C. auris, proper infection prevention and control measures should be taken, including good hand hygiene (either hand washing with soap and water or hand sanitizing with an alcohol-based hand sanitizer) and appropriate and effective environmental cleaning and disinfection using an agent effective against C. auris. C. auris patients should have dedicated equipment, if this is not possible, equipment should be properly cleaned in-between patients. Proper selection, use, and disposal of personal protective equipment (PPE) are essential to prevent transmission; gloves and gown should not be reused or extended. Clear signage should be placed outside the patient’s room to indicate transmission-based precautions and what PPE is needed.  

Treatment 

Most C. auris infections are treatable with a class of antifungal drugs. However, some C. auris infections have been resistant to all three main classes of antifungal medications, making them more difficult to treat. In this situation, multiple classes of antifungals at high doses may be required to treat the infection. Consult a healthcare provider to discuss treatment options and questions regarding fungal infections. 


Reporting Information for Healthcare Providers 

Healthcare providers and laboratories should report the following results via fax to 562-570-4374 or email LBHAI@longbeach.gov within 1 working day:  

  • Detection of C. auris in a specimen using either culture or a validated culture-independent test (e.g., nucleic acid amplification test [NAAT])  

Do not report initial findings unless C. auris is identified in a specimen. For example, do not report a preliminary finding of “Candida species” prior to species identification; however, do report a preliminary finding of “Candida auris”. 

Specimen Submission Requirements 

Laboratories must submit all C. auris isolates from sterile site specimens (e.g., blood) to a public health laboratory within 10 working days. Public health will conduct further testing on isolates submitted, including identification confirmation, antifungal susceptibility testing, and possibly whole genome sequencing. 

  • Laboratories currently submitting isolates directly to the regional public health laboratory in Washington state automatically fulfill this requirement, and do not need to submit additional isolates to a California local or state public health laboratory unless specifically requested to do so. 

Infection Control Measures 

Patients in healthcare facilities often remain colonized with C. auris for many months, perhaps indefinitely, even after an acute infection (if present) has been treated and resolves. Contact Precautions or Enhanced Standard Precautions, depending on the healthcare setting, should be implemented for the entire duration (indefinitely) of all inpatient healthcare stays, including those in long-term healthcare facilities. 

Hospitals: 

Place patients with  C. auris in a single room and implement Standard and Contact Precautions. 

Skilled Nursing Facilities: 

Enhanced Standard Precautions (AFL 22-21) is a resident-centered and activity-based approach for preventing MDRO transmission in skilled nursing facilities (SNF).​ The use of gown and gloves by healthcare personnel during specific high-contact care activities is based on periodic assessments of a resident's risk for being colonized and transmitting MDRO, whether or not the resident is known to be MDRO-colonized or -infected by assessing patient for indwelling devices and unhealing wounds​. 

Patient Placement 

Patients who are colonized or infected with C. auris should be placed in a single room, if possible. If there are a limited number of single rooms available, they should be reserved for patients who may be at highest risk of transmitting C. auris, especially patients that require higher levels of care (e.g., bed-bound). Patients colonized with C. auris and other multidrug-resistant organisms (MDROs) should be placed in rooms with patients colonized with the same MDROs.  

If possible, there should be dedicated staff who care for C. auris patients. To the extent possible, minimize the number of staff who care for the C. auris patient and if there are multiple C. auris patients within the facility, consider cohorting staff who care for these patients. 

  • Place in single room, if possible 

  • If not possible, cohort “like with like” (by carbapenemase, organism and gender) 

  • General Cohorting Principles: 

    • Maintain separation of at least 3 feet between beds. 

    • Use privacy curtains to limit direct contact. 

    • Clean and disinfect as if each bed area were a different room. For example,Clean and disinfect any shared or reusable equipment. 

    • Change mopheads, cleaning cloths, and other cleaning equipment between bed areas. 

    • Clean and disinfect environmental surfaces on a more frequent schedule. 

    • Have healthcare personnel change personal protective equipment (if worn), including gloves, and perform hand hygiene before and after interaction with each roommate.

For more information, see CDPH MDRO Patient Cohorting Guidance. 

Cleaning 

C. auris can survive on surfaces for weeks, therefore, it is essential to ensure environmental services staff (EVS) use EPA registered products effective against C. auris (List P) or Clostridioides spores (List K). EVS should perform routine (at least daily) cleaning and disinfection of patients’ rooms and should focus on high-touch surfaces and shared reusable patient equipment. EVS staff must ensure the disinfectant is left on the surface for the appropriate contact time without being wiped away or disturbed, to effectively kill C. auris 

Effective strategies to improve cleaning and disinfection include:                      

  1. Assign clear disinfection responsibilities 

  1. Develop an audit and feedback program 

  1. Make disinfectants available to all staff  

  1. Train staff on proper cleaning, disinfection, and product use 


Transferring a C. auris patient 

All facilities must communicate the C. auris status of patients, whether suspected or confirmed, to a receiving facility. Facilities should use the Long Beach Infection Control Transfer Form (ideally printed in brightly colored paper and placed on top of discharge paperwork) and should make a phone call to the receiving facility to confirm the information was received. 

Healthcare facilities may NOT refuse new nor returning MDRO positive residents based on infection/colonization status alone.If you need assistance in implementing the appropriate infection controls, please contact the Long Beach Health Department. 


Resources: 


Fact Sheets: 


Questions? Email us at LBHAI@longbeach.gov or call the Communicable Disease Surveillance and Control Division at (562) 570-4302