First reported cases of Candida auris in Victoria: public health actions taken and lessons learned

Ms Donna Cameron1,2, Ms Marion Easton2, Dr Annaliese van Diemen2, Ms Courtney Lane1, Ms Francesca Azzato3, A/Prof Caroline Marshall4, Ms Elizabeth Orr4, A/Prof Leon Worth5,6, Prof Monica Slavin4,5, Ms Jennifer Breen5, Ms Susan Harper5, A/Prof Deborah Williamson1,3

1Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Australia,
2Department of Health and Human Services, Melbourne, Australia,
3Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection & Immunity, Melbourne, Australia,
4Royal Melbourne Hospital, Melbourne, Australia,
5Peter MacCallum Cancer Centre, Melbourne, Australia,
6VICNISS Coordinating Centre at the Peter Doherty Institute for Infection & Immunity, Melbourne, Australia

 

Background:

Candida auris (C. auris) is an emerging healthcare-associated pathogen that presents a serious global health threat. It is often multi-drug resistant, difficult to identify with standard laboratory methods and has been associated with outbreaks in hospital settings. Here we report the first identified cases of C. auris in Victoria and the first identified case of putative transmission within an Australian healthcare facility.

Method:

In July 2018, the Victorian Department of Health and Human Services was advised of a C. auris isolate from a patient hospitalised overseas in November 2017. Contact tracing commenced in two hospitals the patient had been admitted to on return to Australia. A second case identified in August 2018, also had a history of being hospitalised overseas and admissions to the same hospitals as the first case.

Two further epidemiologically unrelated cases were subsequently identified; one screened after direct transfer from an overseas hospital, the other had a clinical specimen following an operation in an overseas facility several years prior. Whole genome sequencing was performed on all four isolates.

Results:

Phylogenetic analysis revealed putative transmission between the first two cases and suspected overseas acquisition in the remaining cases.

Following identification of these cases, the Victorian C. auris Guideline for Health Services was developed. These outline screening, laboratory and infection prevention and control recommendations for the identification and management of C. auris cases.

Conclusion:

Incidences of C. auris incursion into Australia are increasing. Vigilant screening and isolation of at-risk patients is required to prevent further transmission episodes.


Biography:

Donna Cameron is an Infection Control Consultant with the Microbiological Diagnostic Unit Public Health Laboratory and Communicable Diseases Prevention and Control Unit at the Victorian Department of Health and Human. She has been involved with the development and implementation of a number of DHHS guidelines including the suite of Victorian guidelines for carbapenemase-producing Enterobacterales (CPE) and the more recent Victorian guideline on Candida auris for health services.

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