Tuning a UV-C device to challenge new threats in the sanitization setting of healthcare facilities

Abstract Background Environmental hospital hygiene plays a role in healthcare-associated infections emergency caused by resistant multi-drug organisms. The implementation of new and effective disinfection procedures is now more than ever important to prevent the cross-transmission of pathogens in the hospital facilities. In combination with common chemicals biocides, UV technology is a realistic option for environmental disinfection. In this study, we evaluate a UV device for its effectiveness on an emerging pathogen. Methods A laboratory cross section experiment was performed between August and October 2019. Two different strains of Candida auris (CBS 10913 and CBS 12372) were tested on 20 cm2 stainless steel carriers inoculated with 10 µl of bacterial culture at a concentration of 1x105 CFU/mL. The inoculum was spread until dry in aseptic condition. Carriers were placed parallel to the UV device, having 4 UV-C lamps that emit 325 W, at a fixed distance of 2.44 m. Biocidal tests were carried out in triple at three different light exposure times (5, 10 and 20 minutes). After treatment, laboratories procedures were used to detach and transfer the remaining microorganisms from the carriers to plates and compared them to controls after incubation at 37 °C for 48 h. Results A significant inactivation of C. auris already occurred at 5 minutes, reaching 3-4 log10 reduction at 20 minutes of UV-C exposure. No substantial differences were identified by analyzing the results between the two strains. Conclusions The chosen distance of 2.44 m from the target allows to ideally sanitize an entire hospital room. However, to avoid the limit of shaded areas due to the presence of non-movable objects, a couple of positions are recommended, so that shorter distances can reduce the exposure time or increase the average irradiance level of exposed surfaces. Key messages In sanitation of hospital environments, the use of viable alternatives as UV-C can contribute to the reduction of infections caused by multidrug-resistant microorganisms. Accurate testing of different space-time irradiation configurations allows to achieve important results related to the biocidal effects of UV devices.

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Relative Resistance of the Emerging Fungal Pathogen Candida auris and Other Candida Species to Killing by Ultraviolet Light

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.239 ◽

2017 ◽

Vol 39 (1) ◽

pp. 94-96 ◽

Cited By ~ 26

Author(s):

Jennifer L. Cadnum ◽

Aaron A. Shaikh ◽

Christina T. Piedrahita ◽

Annette L. Jencson ◽

Emily L. Larkin ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Candida Species ◽

Fungal Pathogen ◽

Laboratory Testing ◽

Multidrug Resistant ◽

Relative Resistance ◽

Candida Auris ◽

Healthcare Facilities ◽

Ultraviolet C ◽

Uv C

Mobile ultraviolet-C (UV-C) light room decontamination devices are frequently used as an adjunct to standard cleaning in healthcare facilities, but their efficacy in killing Candida species is not clear. In laboratory testing, the emerging multidrug-resistant Candida auris and 2 other Candida species were significantly less susceptible to killing by UV-C than methicillin-resistant Staphylococcus aureus.Infect Control Hosp Epidemiol 2018;39:94–96

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Silver nanoantibiotics display strong antifungal activity against the emergent multidrug-resistant yeast Candida auris under both planktonic and biofilm growing conditions

10.1101/2020.05.31.126433 ◽

2020 ◽

Author(s):

Roberto Vazquez-Munoz ◽

Fernando D. Lopez ◽

Jose Lopez-Ribot

Keyword(s):

Antimicrobial Activity ◽

Multidrug Resistant ◽

Clinical Settings ◽

Candida Auris ◽

Pathogenic Yeast ◽

Biofilm Growth ◽

Healthcare Facilities ◽

Ic50 Values ◽

Growing Conditions ◽

Different Strains

AbstractCandida auris is an emergent multidrug-resistant pathogenic yeast with an unprecedented ability for a fungal organism to easily spread between patients in clinical settings, leading to major outbreaks in healthcare facilities. The formation of biofilms by C. auris contributes to infection and its environmental persistence. Most antifungals and sanitizing procedures are not effective against C. auris, but antimicrobial nanomaterials could represent a viable alternative to combat the infections caused by this emerging pathogen. We have previously described an easy and inexpensive method to synthesize silver nanoparticles (AgNPs) in non-specialized laboratories. Here we have assessed the antimicrobial activity of the resulting AgNPs on C. auris planktonic and biofilm growth phases. AgNPs displayed a strong antimicrobial activity against all the stages of all C. auris strains tested, representative of four different clades. Under planktonic conditions, MIC values of AgNPs against the different strains were <0.5 μg mL-1; whereas calculated IC50 values for inhibition of biofilms formation were < 2 μg mL-1 for all but one of the C. auris strains tested. AgNPs were also active against preformed biofilms formed by all different C. auris strains, with IC50 values ranging from 1.2 to 6.2 μg mL-1. Overall, our results indicate potent activity of AgNPs against strains of C. auris, both under planktonic and biofilm growing conditions, and indicate that AgNPs may contribute to the control of infections caused by this emerging nosocomial threat.

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Two Candida auris Cases in Germany with No Recent Contact to Foreign Healthcare—Epidemiological and Microbiological Investigations

Journal of Fungi ◽

10.3390/jof7050380 ◽

2021 ◽

Vol 7 (5) ◽

pp. 380

Author(s):

Joerg Steinmann ◽

Thomas Schrauzer ◽

Lisa Kirchhoff ◽

Jacques F. Meis ◽

Peter-Michael Rath

Keyword(s):

South Asian ◽

Multidrug Resistant ◽

Health Care Facilities ◽

Candida Auris ◽

Contact Precautions ◽

Asian Clade ◽

Care Facilities ◽

Long Time ◽

European Health ◽

Healthcare Associated

Candida auris has become a global fungal public health threat. This multidrug-resistant yeast is associated with nosocomial intra- and interhospital transmissions causing healthcare-associated infections. Here, we report on two C. auris cases from Germany. The two patients stayed in Germany for a long time before C. auris was detected during their hospitalization. The patients were isolated in single rooms with contact precautions. No nosocomial transmissions were detected within the hospital. Both C. auris isolates exhibited high minimum inhibitory concentrations (MICs) of fluconazole and one isolate additionally high MICs against the echinocandins. Microsatellite genotyping showed that both strains belong to the South Asian clade. These two cases are examples for appropriate in-hospital care and infection control without further nosocomial spread. Awareness for this emerging, multidrug-resistant pathogen is justified and systematic surveillance in European health care facilities should be performed.

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Inactivation of Candida auris and Candida albicans by Ultraviolet-C

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.868 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s292-s292

Author(s):

William Rutala ◽

Hajime Kanamori ◽

Maria Gergen ◽

Emily Sickbert-Bennett ◽

David Jay Weber

Keyword(s):

Infection Prevention ◽

Antifungal Drugs ◽

Candida Auris ◽

Healthcare Facilities ◽

Environmental Surfaces ◽

Route Of Transmission ◽

Indirect Exposure ◽

Ultraviolet C ◽

Severe Infections ◽

Uv C

Background:Candida auris is an emerging fungal pathogen that is often resistant to major classes of antifungal drugs. It is considered a serious global health threat because it has caused severe infections with frequent mortality in over a dozen countries. C. auris can survive on healthcare environmental surfaces for at least 7 days, and it causes outbreaks in healthcare facilities. C. auris has an environmental route of transmission. Thus, infection prevention strategies, such as surface disinfection and room decontamination technologies (eg, ultraviolet [UV-C] light), will be essential to controlling transmission. Unfortunately, data are limited regarding the activity of UV-C to inactivate this pathogen. In this study, a UV-C device was evaluated for its antimicrobial activity against C. auris and C. albicans. Methods: We tested the antifungal activity of a single UV-C device using the vegetative bacteria cycle, which delivers a reflected dose of 12,000 µW/cm2. This testing was performed using Formica sheets (7.6 × 7.6 cm; 3 × 3 inches). The carriers were inoculated with C. auris or C. albicans and placed horizontal on the surface or vertical (ie, perpendicular) to the vertical UV-C lamp and at a distance from 1. 2 m (~4 ft) to 2.4 m (~8 ft). Results: Direct UV-C, with or without FCS (log10 reduction 4.57 and 4.45, respectively), exhibited a higher log10 reduction than indirect UV-C for C. auris (log10 reduction 2.41 and 1.96, respectively), which was statistically significant (Fig. 1 and Table 1). For C. albicans, although direct UV-C had a higher log10 reduction (log10 reduction with and without FCS, 5.26 and 5.07, respectively) compared to indirect exposure (log10 reduction with and without FCS, 3.96 and 3.56, respectively), this difference was not statistically significant. The vertical UV had statistically higher log10 reductions than horizontal UV against C. auris and C. albicans with FCS and without FCS. For example, for C. auris with FCS the log10 reduction for vertical surfaces was 4.92 (95% CI 3.79, 6.04) and for horizontal surfaces the log10 reduction was 2.87 (95% CI, 2.36–3.38). Conclusions:C. auris can be inactivated on environmental surfaces by UV-C as long as factors that affect inactivation are optimized (eg, exposure time). These data and other published UV-C data should be used in developing cycle parameters that prevent contaminated surfaces from being a source of acquisition by staff or patients of this globally emerging pathogen.Funding: NoneDisclosures: None

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1579. Multidrug-Resistant Candida auris Isolates From New York Hospitals and Healthcare Facilities Are Susceptible to Antifungal Combinations

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1443 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S576-S577

Author(s):

Brittany O’Brien ◽

Sudha Chaturvedi ◽

Vishnu Chaturvedi

Keyword(s):

New York ◽

Diagnostic System ◽

Multidrug Resistant ◽

Drug Combinations ◽

Antifungal Drugs ◽

Drug Resistant ◽

Candida Auris ◽

Current Case ◽

Healthcare Facilities ◽

Broth Microdilution Method

Abstract Background Candida auris outbreak continues unabated in New York with the current case counts exceeding 300 patients. We used a modification of standard CLSI broth microdilution method (BMD) if two-drug combinations are efficacious against C. auris isolates with high-resistance to fluconazole (FZ, MIC50 >256 mg/L), and variable resistance to other broad-spectrum antifungal drugs. Methods BMD plates were custom-designed and quality controlled by TREK Diagnostic System. The combination tests of 15 drug-resistant C. auris involved microtiter wells with the initial 144 two-drug combinations and their two-fold dilutions (1/2–1/32) to get 864 two-drug combinations finally. We utilized MIC100 endpoints for the drug combination readings as reported earlier for the intra- and inter-laboratory agreements obtained against Candida species and Aspergillus fumigatus (Antimicrob Agents Chemother. 2015. 59:1759–1766). We also tested minimum fungicidal concentrations (MFC). Results We tested all possible 864 two-drug antifungal combinations for nine antifungal drugs in use to yield 12,960 MIC100 readings, and MFC readings for 15 C. auris isolates. Flucytosine (FLC) at 2.0 mg/L potentiated most successful combinations with other drugs. Micafungin (MFG), Anidulafungin (AFG), Caspofungin (CAS) at individual concentrations of 0.25 mg/L combined well with FLC (2.0 mg/L) to yield MIC100 for 14, 13, and 12 of 15 C. auris isolates tested, respectively. MFG/FLC combination was also fungicidal for 4 of 15 isolates. AMB / FLC (0.25/1.0 mg/L) yielded MIC100 for 13 isolates and MFC for three test isolates. Posaconazole (POS), and Isavuconazole (ISA) and Voriconazole (VRC) also combined well with FLC (0.25/2.0 mg/L) to yield MIC100 for 12, 13, and 13 isolates, respectively. POS/FLC combination was fungicidal for three isolates. Conclusion We identified seven two drug-combinations of antifungals efficacious against drug-resistant C. auris strains. The modified BMD combination susceptibility testing could be used by the clinical laboratories to assist providers with the selection of optimal treatment for C. auris candidemia. Disclosures All authors: No reported disclosures.

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Bismuth Nanoantibiotics Display Anticandidal Activity and Disrupt the Biofilm and Cell Morphology of the Emergent Pathogenic Yeast Candida auris

Antibiotics ◽

10.3390/antibiotics9080461 ◽

2020 ◽

Vol 9 (8) ◽

pp. 461

Author(s):

Roberto Vazquez-Munoz ◽

Fernando D. Lopez ◽

Jose L. Lopez-Ribot

Keyword(s):

Antimicrobial Activity ◽

Cell Morphology ◽

Multidrug Resistant ◽

Moderate Activity ◽

Candida Auris ◽

Pathogenic Yeast ◽

Biofilm Growth ◽

Healthcare Facilities ◽

Bismuth Nanoparticles ◽

Ic50 Values

Candida auris is an emergent multidrug-resistant pathogenic yeast, which forms biofilms resistant to antifungals, sanitizing procedures, and harsh environmental conditions. Antimicrobial nanomaterials represent an alternative to reduce the spread of pathogens—including yeasts—regardless of their drug-resistant profile. Here we have assessed the antimicrobial activity of easy-to-synthesize bismuth nanoparticles (BiNPs) against the emergent multidrug-resistant yeast Candida auris, under both planktonic and biofilm growing conditions. Additionally, we have examined the effect of these BiNPs on cell morphology and biofilm structure. Under planktonic conditions, BiNPs MIC values ranged from 1 to 4 µg mL−1 against multiple C. auris strains tested, including representatives of all different clades. Regarding the inhibition of biofilm formation, the calculated BiNPs IC50 values ranged from 5.1 to 113.1 µg mL−1. Scanning electron microscopy (SEM) observations indicated that BiNPs disrupted the C. auris cell morphology and the structure of the biofilms. In conclusion, BiNPs displayed strong antifungal activity against all strains of C. auris under planktonic conditions, but moderate activity against biofilm growth. BiNPs may potentially contribute to reducing the spread of C. auris strains at healthcare facilities, as sanitizers and future potential treatments. More research on the antimicrobial activity of BiNPs is warranted.

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Outbreak of Healthcare-Associated Infection and Colonization With Multidrug-ResistantSalmonella entericaSerovar Senftenberg in Florida

Infection Control and Hospital Epidemiology ◽

10.1086/518458 ◽

2007 ◽

Vol 28 (7) ◽

pp. 805-811 ◽

Cited By ~ 16

Author(s):

Robyn S. Kay ◽

Alexander G. Vandevelde ◽

Paul D. Fiorella ◽

Rebecca Crouse ◽

Carina Blackmore ◽

...

Keyword(s):

Infection Control ◽

Chronically Ill ◽

Multidrug Resistant ◽

Control Measures ◽

Healthcare Associated Infection ◽

Healthcare Facilities ◽

Infection Control Measures ◽

Healthcare Associated ◽

Chronically Ill Patients

Background.In July 1999, a rare strain of multidrug-resistantSalmonella entericaserovar Senftenberg was isolated from the sputum of a trauma patient. Over a 6-year period (1999-2005) in northeast Florida, thisSalmonellaserovar spread to 66 other patients in 16 different healthcare facilities as a result of frequent transfers of patients among institutions. To our knowledge, this is the first outbreak of healthcare-associated infection and colonization with a fluoroquinolone-resistant strain of S. Senftenberg in the United States.Objectives.To investigate an outbreak of infection and colonization with an unusual strain of S. Senftenberg and assist with infection control measures.Design.A case series, outbreak investigation, and microbiological study of all samples positive forS.Senftenberg on culture.Setting.Cases ofS.Senftenberg infection and colonization occurred in hospitals and long-term care facilities in 2 counties in northeast Florida.Results.The affected patients were mostly elderly persons with multiple medical conditions. They were frequently transferred between healthcare facilities. ThisSalmonellaserovar was capable of long-term colonization of chronically ill patients. AllS.Senftenberg isolates tested shared a similar pulsed-field gel electrophoresis (PFGE) pattern.Conclusion.A prolonged outbreak of infection and colonization with multidrug-resistantS.Senftenberg was identified in several healthcare facilities throughout the Jacksonville, Florida, area and became established when infection control measures failed. The bacterial agent was capable of long-term colonization in chronically ill patients. Because the dispersal pattern of this strain suggested a breakdown of infection control practices, a multipronged intervention approach was undertaken that included intense education of personnel in the different institutions, interinstitutional cooperation, and transfer paperwork notification.

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1687. High-Rates of Candida auris Carriage and Co-Colonization with Multidrug-Resistant Organisms (MDROs)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1551 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S617-S617

Author(s):

Ruby Barza ◽

Parul Patel ◽

Jignesh Patel ◽

Lauren E Droske ◽

Donna Schora ◽

...

Keyword(s):

Multidrug Resistant ◽

High Rate ◽

Diffusion Method ◽

Candida Auris ◽

Prevalence Survey ◽

E Coli ◽

Carbapenem Resistant ◽

Few Data ◽

Healthcare Associated

Abstract Background Candida auris is an emerging multidrug-resistant pathogen that can persist in the environment and lead to healthcare-associated outbreaks. Residents of long-term acute care hospitals (LTACHs) are at particular risk for carriage of both MDROs and C. auris. However, there are few data on co-colonization rates of C. auris with other MDROs in LTACHs. Methods We conducted a point prevalence survey for MDROs, C. auris and C. difficile in a Chicago LTACH in March 2019. A combined axilla/groin E-swab (Copan) was collected and plated for C. auris isolation using CHROMagar Candida (Hardy). A rectal E-swab (Copan) was collected for C difficile PCR and MDRO detection including Carbapenem-resistant Enterobacteriaceae (CRE), Extended-spectrum B-lactamases (ESBLs) and Vancomycin-resistant Enterococci (VRE). Each swab was plated directly on VACC agar (Vancomycin, Amphotericin B, Ceftazidime, Clindamycin) and CHROMagar ESBL (Hardy). Bruker MALDI-TOF was used for bacterial and yeast identification and disc diffusion method for antimicrobial susceptibility testing. ESBL phenotypic confirmation was done using double-disc synergy method per CLSI guidelines. Carbapenemase production was confirmed using Xpert Carba-R assay (Cepheid). C. difficile PCR was performed using Xpert C. difficile/Epi assay (Cepheid). Results Of 38 patients 36 were eligible for the study (2 patients declined). Overall, 26/36 (72%) patients had an MDRO. Eight (22%) patients were positive for C. auris. Eight (22%) patients had ESBLs (2 P. mirabilis and 6 E. coli), six (17%) had CREs that were all blaKPC positive (4 K. pneumonia, 1 E. coli, and K. pneumoniae). Eight (22%) patients were positive for other gram-negative (GN)-MDROs including 1 A. baumanii, 3 P. aeruginosa, 2 E. cloacae, 1 E. asburiae and 1 P. aeruginosa, and A. baumanii. 20 patients (56%) had VRE colonization. Five (14%) were C. difficile PCR positive. 7/ 8 (87.5%) patients with C. auris were also colonized with another MDRO (2 VRE, 1 ESBL, 1 VRE, ESBL and KPC, 1 VRE and GN-MDRO, 1 VRE, ESBL and GN-MDRO, 1 VRE, KPC, and GN-MDRO). Conclusion We found a high rate of MDRO co-colonization among patients with C. auris carriage. Continuous active surveillance may be appropriate in LTACHs to limit the spread of C. auris and other MDROs. Disclosures All authors: No reported disclosures.

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Comparative molecular and immunoregulatory analysis of extracellular vesicles from Candida albicans and Candida auris

10.1101/2020.11.04.368472 ◽

2020 ◽

Author(s):

Daniel Zamith-Miranda ◽

Heino M. Heyman ◽

Sneha P. Couvillion ◽

Radames J. B. Cordero ◽

Macio L. Rodrigues ◽

...

Keyword(s):

Extracellular Vesicles ◽

Pathogenic Fungus ◽

Cell Monolayer ◽

Bloodstream Infections ◽

Multidrug Resistant ◽

Immune Defense ◽

Potential Contribution ◽

Candida Auris ◽

Activation Markers ◽

Healthcare Associated

AbstractCandida auris is a recently described multidrug-resistant pathogenic fungus that is increasingly responsible for healthcare associated outbreaks across the world. Bloodstream infections of this fungus cause death in up to 70% of the cases. Aggravating this scenario, C. auris’ disease-promoting mechanisms are poorly understood. Fungi release extracellular vesicles (EVs) carrying a broad range of molecules including proteins, lipids, carbohydrates, pigments, and RNA, many of which are virulence factors. Here, we carried out a comparative molecular characterization of C. auris and C. albicans EVs and evaluated their capacity to modulate effector mechanisms of host immune defense. Using proteomics, lipidomics, and transcriptomics, we found that C. auris released EVs with payloads that were strikingly different from EVs released by C. albicans. EVs released by C. auris potentiated the adhesion of this yeast to an epithelial cell monolayer. C. auris EVs also induced the expression of surface activation markers and cytokines by bone marrow-derived dendritic cells. Altogether, our findings show distinct profiles and properties of EVs released by C. auris and by C. albicans, and highlight the potential contribution of C. auris EVs to the pathogenesis of this emerging pathogen.

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What Do We Know about Candida auris? State of the Art, Knowledge Gaps, and Future Directions

Microorganisms ◽

10.3390/microorganisms9102177 ◽

2021 ◽

Vol 9 (10) ◽

pp. 2177

Author(s):

Victor Garcia-Bustos ◽

Marta D. Cabanero-Navalon ◽

Amparo Ruiz-Saurí ◽

Alba C. Ruiz-Gaitán ◽

Miguel Salavert ◽

...

Keyword(s):

Multidrug Resistant ◽

Current Evidence ◽

Knowledge Gaps ◽

Candida Auris ◽

Future Directions ◽

International Agencies ◽

Health Authorities ◽

Control And Prevention ◽

Global Threat ◽

Healthcare Associated

Candida auris has unprecedently emerged as a multidrug resistant fungal pathogen, considered a serious global threat due to its potential to cause nosocomial outbreaks and deep-seated infections with staggering transmissibility and mortality, that has put health authorities and institutions worldwide in check for more than a decade now. Due to its unique features not observed in other yeasts, it has been categorised as an urgent threat by the Centers for Disease Control and Prevention and other international agencies. Moreover, epidemiological alerts have been released in view of the increase of healthcare-associated C. auris outbreaks in the context of the COVID-19 pandemic. This review summarises the current evidence on C. auris since its first description, from virulence to treatment and outbreak control, and highlights the knowledge gaps and future directions for research efforts.

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