학술논문
Rapid Environmental Contamination With Candida auris and Multidrug-Resistant Bacterial Pathogens Near Colonized Patients
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article
Author
Sansom, Sarah E; Gussin, Gabrielle M; Schoeny, Michael; Singh, Raveena D; Adil, Hira; Bell, Pamela; Benson, Ellen C; Bittencourt, Cassiana E; Black, Stephanie; Del Mar Villanueva Guzman, Maria; Froilan, Mary Carl; Fukuda, Christine; Barsegyan, Karina; Gough, Ellen; Lyman, Meghan; Makhija, Jinal; Marron, Stefania; Mikhail, Lydia; Noble-Wang, Judith; Pacilli, Massimo; Pedroza, Robert; Saavedra, Raheeb; Sexton, D Joseph; Shimabukuro, Julie; Thotapalli, Lahari; Zahn, Matthew; Huang, Susan S; Hayden, Mary K
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Abstract
BackgroundEnvironmental contamination is suspected to play an important role in Candida auris transmission. Understanding speed and risks of contamination after room disinfection could inform environmental cleaning recommendations.MethodsWe conducted a prospective multicenter study of environmental contamination associated with C. auris colonization at six ventilator-capable skilled nursing facilities and one acute-care hospital in Illinois and California. Known C. auris carriers were sampled at five body-sites followed by sampling of nearby room surfaces before disinfection and at 0, 4, 8, and 12-hours post-disinfection. Samples were cultured for C. auris and bacterial multidrug-resistant organisms (MDROs). Odds of surface contamination after disinfection were analyzed using multilevel generalized estimating equations.ResultsAmong 41 known C. auris carriers, colonization was detected most frequently on palms/fingertips (76%) and nares (71%). C. auris contamination was detected on 32.2% (66/205) of room surfaces pre-disinfection and 20.5% (39/190) of room surfaces by 4-hours post-disinfection. A higher number of C. auris-colonized body sites was associated with higher odds of environmental contamination at every time point following disinfection, adjusting for facility of residence. In the rooms of 38 (93%) C. auris carriers co-colonized with a bacterial MDRO, 2%-24% of surfaces were additionally contaminated with the same MDRO by 4-hours post-disinfection.ConclusionsC. auris can contaminate the healthcare environment rapidly after disinfection, highlighting the challenges associated with environmental disinfection. Future research should investigate long-acting disinfectants, antimicrobial surfaces, and more effective patient skin antisepsis to reduce the environmental reservoir of C. auris and bacterial MDROs in healthcare settings.