METHODS: Cases were classified as clinical or screening depending on whether cultures were obtained for diagnostic or surveillance purposes. Case finding involved advising healthcare facilities and laboratories to notify the NYS Department of Health (NYSDOH) of potential cases and suspicious isolates. Surveillance methods included culturing contacts, conducting point prevalence surveys, and collecting environmental cultures. Site visits were conducted when transmission was suspected. Isolates were identified using matrix-assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS). Antifungal susceptibility testing was performed.
RESULTS: As of March 17, 2017, 35 clinical and 15 screening cases had been reported. Clinical cases were identified in 13 acute care hospitals, one long term acute care hospital, and one private medical office. All but one were identified in the downstate metropolitan area. Screening cases were identified in four hospitals and two LTCFs where clinical case patients had resided; additionally, one was a family member of a clinical case from a third LTCF. Environmental cultures were obtained in 11 facilities and were positive in 2/5 LTCFs and 3/6 hospitals. Site visits identified areas for improvement in infection control, such as adherence to hand hygiene recommendations and contact precautions. Isolates from 34/35 clinical cases were susceptible to echinocandins and resistant to fluconazole and amphotericin B. The isolate from one clinical case was susceptible to all drugs tested.
CONCLUSIONS: This large cluster of C. auris cases affecting healthcare facilities in NYS represents the majority of cases reported in the United States to date. It is unclear why so many cases have been reported from the NYS downstate metropolitan area; it might reflect a higher prevalence in this international port of entry, more complete detection, or a combination of these and other factors. The identification of screening cases demonstrates the importance of contact tracing, and the positive environmental cultures emphasize the importance of environmental disinfection. A limitation is the frequent inability to determine where the organism was acquired because of multiple healthcare facility exposures. Aggressive responses and surveillance might blunt the ultimate impact of C. auris on NYS.