Researchers have linked an outbreak of the Candida auris fungus in Oxford University Hospitals’ Neurosciences Intensive Care Unit (NICU) to multi-use patient monitoring equipment, including underarm thermometers.
Candida auris, or C. auris, is an emerging drug-resistant pathogen that originated from Japan. The fungus is generally resistant to many antifungal drugs, including fluconazole and related treatments, and sometimes amphotericin. C. auris belongs to the yeast family and can live both on the skin and inside the body, where it causes complications in patients with weakened immune systems.
Until now, little was known about how C. auris was spreading. A new study presented at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) on Saturday analysed 70 patients with C. auris between February 2015 and August 2017. Of those patients, 66 were admitted to the NICU before being diagnosed.
Researchers found that multi-use thermometers had been used in 86% of the patients who were admitted to the NICU before being diagnosed with C. auris. The team cultured fungal samples from medical equipment and, using a scanning electron microscope, examined it on the surface of temperature probes. After analysing genetic information in the fungal samples, the team found that it matched fungal samples taken from patients.
Even after controlling for other factors, including time spent in the NICU, blood test results and level of illness, researchers found using these thermometers increased the risk of having C. auris. The study also showed that although equipment was washed, it still spread the fungus between patients in the NICU.
“Despite a bundle of infection control interventions, the outbreak was only controlled following removal of the temperature probes,” said study author Dr David Eyre from the Nuffield Department of Medicine at the University of Oxford.
“This reinforces the need to carefully investigate the environment, and in particular multi-use patient equipment, in any unexplained healthcare-associated outbreak,” he added.
The study found that although seven patients developed invasive fungal infections, none of them died as a result. While the reasons for C. auris spreading are still not well understood, researchers hope the study will help control the rise of these types of fungal infections.
On Friday, the United States Food and Drug Administration (FDA) authorised the first test for the C. auris pathogen. The FDA now allows the marketing of a type of mass spectrometry technology called the Bruker MALDI Biotyper CA System to identify C. auris, in addition to 424 other bacteria and yeast species with clinical relevance.
Donald St. Pierre from the FDA’s Center for Devices and Radiological Health said in a statement: “The FDA has confidence in this technology and recognises the need to rapidly address outbreaks both for C. auris and for other pathogenic microorganisms.”