BACKGROUND: Candida auris is an emerging, multidrug-resistant yeast causing invasive infections globally but not reported in the United States before 2016. In August 2016, the Chicago Department of Public Health was notified of 2 patients with C. auris infections who were treated at the same acute care hospital (ACH) and long-term acute care hospital (LTACH). We investigated possible health care transmission to guide control measures.
METHODS: Cases were defined as C. auris isolated from clinical cultures. We reviewed medical records to identify overlaps in time and location; sampled patients’ rooms; and screened patients, ACH ward-mates, and LTACH patients for colonization. Isolates were analyzed using whole genome sequencing (WGS).
RESULTS: C. auris was isolated from Patient 1’s bloodstream in May and Patient 2’s urine in July. These patients had 3 overlapping ACH admissions during March–July, but wards differed. In April, 3 days separated their hospitalizations on the same LTACH ward. In August, we detected C. auris colonization of index patients’ skin, nares, vagina, and rectum. C. auris was present on mattress, bed rail, chair, table, and window ledge surfaces in Patient 1’s hospital room. Three (6%) of 50 sampled LTACH patients, hospitalized on the same ward as both index patients, exhibited C. auris colonization; no ACH ward-mates were colonized. All available patient isolates were highly related (<10 single nucleotide polymorphisms) by WGS.
CONCLUSIONS: Nearly indistinguishable C. auris strains were isolated from patients exposed to a single Chicago LTACH ward, indicating likely health care-associated transmission. Persistent colonization of patients, health care environment contamination, and ward-mate colonization necessitate ongoing patient and environmental surveillance, strict adherence to Standard and Contact Precautions, and thorough environmental decontamination to control spread.