scholarly journals Laboratory Analysis of an Outbreak of Candida auris in New York from 2016 to 2018: Impact and Lessons Learned

2019 ◽  
Vol 58 (4) ◽  
Author(s):  
YanChun Zhu ◽  
Brittany O’Brien ◽  
Lynn Leach ◽  
Alexandra Clarke ◽  
Marian Bates ◽  
...  
Keyword(s):  
Health Care ◽  
New York ◽  
Real Time ◽  
Real Time Pcr ◽  
Health Care Facilities ◽  
Clinical Isolates ◽  
Environmental Surveillance ◽  
Candida Auris ◽  
Content Type ◽  
Care Facilities

ABSTRACT Candida auris is a multidrug-resistant yeast which has emerged in health care facilities worldwide; however, little is known about identification methods, patient colonization, environmental survival, spread, and drug resistance. Colonization on both biotic (patients) and abiotic (health care objects) surfaces, along with travel, appear to be the major factors for the spread of this pathogen across the globe. In this investigation, we present laboratory findings from an ongoing C. auris outbreak in New York (NY) from August 2016 through 2018. A total of 540 clinical isolates, 11,035 patient surveillance specimens, and 3,672 environmental surveillance samples were analyzed. Laboratory methods included matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) for yeast isolate identification, real-time PCR for rapid surveillance sample screening, culture on selective/nonselective media for recovery of C. auris and other yeasts from surveillance samples, antifungal susceptibility testing to determine the C. auris resistance profile, and Sanger sequencing of the internal transcribed spacer (ITS) and D1/D2 regions of the ribosomal gene for C. auris genotyping. Results included (a) identification and confirmation of C. auris in 413 clinical isolates and 931 patient surveillance isolates as well as identification of 277 clinical cases and 350 colonized cases from 151 health care facilities, including 59 hospitals, 92 nursing homes, 1 long-term acute care hospital (LTACH), and 2 hospices, (b) successful utilization of an in-house developed C. auris real-time PCR assay for the rapid screening of patient and environmental surveillance samples, (c) demonstration of relatively heavier colonization of C. auris in nares than in the axilla/groin, and (d) predominance of the South Asia clade I with intrinsic resistance to fluconazole and elevated MIC to voriconazole (81%), amphotericin B (61%), flucytosine (5FC) (3%), and echinocandins (1%). These findings reflect greater regional prevalence and incidence of C. auris and the deployment of better detection tools in an unprecedented outbreak.

scholarly journals Molecular Survey of the Dissemination of TwoblaKPC-Harboring IncFIA Plasmids in New Jersey and New York Hospitals

2014 ◽  
Vol 58 (4) ◽  
pp. 2289-2294 ◽  
Author(s):  
Liang Chen ◽  
Kalyan D. Chavda ◽  
Roberto G. Melano ◽  
Tao Hong ◽  
Albert D. Rojtman ◽  
...  
Keyword(s):  
Health Care ◽  
New York ◽  
New Jersey ◽  
Plasmid Transfer ◽  
Health Care Facilities ◽  
Conjugative Plasmid ◽  
Content Type ◽  
Care Facilities ◽  
Clonal Spread ◽  
Sequence Types

ABSTRACTKlebsiella pneumoniaecarbapenemase (KPC)-producingK. pneumoniaestrains have spread worldwide and become a major threat in health care facilities. Transmission ofblaKPC, the plasmid-borne KPC gene, can be mediated by clonal spread and horizontal transfer. Here, we report the complete nucleotide sequences of two novelblaKPC-3-harboring IncFIA plasmids, pBK30661 and pBK30683. pBK30661 is 74 kb in length, with a mosaic plasmid structure; it exhibits homologies to several other plasmids but lacks the plasmid transfer operon (tra) and the origin of transfer (oriT) that are required for plasmid transfer. pBK30683 is a conjugative plasmid with a cointegrated plasmid structure, comprising a 72-kb element that highly resembles pBK30661 (>99.9% nucleotide identities) and an extra 68-kb element that harborstraandoriT. A PCR scheme was designed to detect the distribution ofblaKPC-harboring IncFIA (pBK30661-like and pBK30683-like) plasmids in a collection of clinicalEnterobacteriaceaeisolates from 10 hospitals in New Jersey and New York. KPC-harboring IncFIA plasmids were found in 20% of 491K. pneumoniaeisolates, and all carriedblaKPC-3. pBK30661-like plasmids were identified mainly in the epidemic sequence type 258 (ST258)K. pneumoniaeclone, while pBK30683-like plasmids were widely distributed in ST258 and otherK. pneumoniaesequence types and among non-K. pneumoniae Enterobacteriaceaespecies. This suggests that both clonal spread and horizontal plasmid transfer contributed to the dissemination ofblaKPC-harboring IncFIA plasmids in our area. Further studies are needed to understand the distribution of this plasmid group in other health care regions and to decipher the origins of pBK30661-like and pBK30683-like plasmids.

scholarly journals Survival, Persistence, and Isolation of the Emerging Multidrug-Resistant Pathogenic Yeast Candida auris on a Plastic Health Care Surface

2017 ◽  
Vol 55 (10) ◽  
pp. 2996-3005 ◽  
Author(s):  
Rory M. Welsh ◽  
Meghan L. Bentz ◽  
Alicia Shams ◽  
Hollis Houston ◽  
Amanda Lyons ◽  
...  
Keyword(s):  
Health Care ◽  
Multidrug Resistant ◽  
Health Care Facilities ◽  
Candida Auris ◽  
Pathogenic Yeast ◽  
Content Type ◽  
Health Care Settings ◽  
Care Facilities ◽  
Enrichment Protocol ◽  
Plastic Surfaces

ABSTRACTThe emerging multidrug-resistant pathogenic yeastCandida aurisrepresents a serious threat to global health. Unlike most otherCandidaspecies, this organism appears to be commonly transmitted within health care facilities and causes health care-associated outbreaks. To better understand the epidemiology of this emerging pathogen, we investigated the ability ofC. auristo persist on plastic surfaces common in health care settings compared with that ofCandida parapsilosis, a species known to colonize the skin and plastics. Specifically, we compiled comparative and quantitative data essential to understanding the vehicles of spread and the ability of both species to survive and persist on plastic surfaces under controlled conditions (25°C and 57% relative humidity), such as those found in health care settings. When a test suspension of 104cells was applied and dried on plastic surfaces,C. aurisremained viable for at least 14 days andC. parapsilosisfor at least 28 days, as measured by CFU. However, survival measured by esterase activity was higher forC. auristhanC. parapsilosisthroughout the 28-day study. Given the notable length of timeCandidaspecies survive and persist outside their host, we developed methods to more effectively cultureC. aurisfrom patients and their environment. Using our enrichment protocol, public health laboratories and researchers can now readily isolateC. aurisfrom complex microbial communities (such as patient skin, nasopharynx, and stool) as well as environmental biofilms, in order to better understand and preventC. auriscolonization and transmission.

scholarly journals Laboratory Analysis of an Outbreak of Candida auris in New York from 2016 to 2018-Impact and Lessons Learned

2019 ◽  
Author(s):  
YanChun Zhu ◽  
Brittany O’Brien ◽  
Lynn Leach ◽  
Alexandra Clark ◽  
Marian Bates ◽  
...  
Keyword(s):  
Real Time ◽  
Real Time Pcr ◽  
Antifungal Susceptibility ◽  
Clinical Isolates ◽  
Rapid Screening ◽  
Care Hospital ◽  
Environmental Surveillance ◽  
Intrinsic Resistance ◽  
Candida Auris ◽  
Healthcare Facilities

ABSTRACTCandida auris is a multidrug-resistant yeast which has emerged in healthcare facilities worldwide, however little is known about identification methods, patient colonization, spread, environmental survival, and drug resistance. Colonization on both biotic and abiotic surfaces, along with travel, appear to be the major factors for the spread of this pathogen across the globe. In this investigation, we present laboratory findings from an ongoing C. auris outbreak in NY from August 2016 through 2018. A total of 540 clinical isolates, 11,035 patient surveillance specimens, and 3,672 environmental surveillance samples were analyzed. Laboratory methods included matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) for yeast isolate identification, real-time PCR for rapid surveillance sample screening, culture on selective/non-selective media for recovery of C. auris and other yeasts from surveillance samples, antifungal susceptibility testing to determine the C. auris resistance profile, and Sanger sequencing of ribosomal genes for C. auris genotyping. Results included: a) identification and confirmation of C. auris in 413 clinical isolates and 931 patient surveillance isolates, as well as identification of 277 clinical cases and 350 colonized cases from 151 healthcare facilities including 59 hospitals, 92 nursing homes, 1 long-term acute care hospital (LTACH), and 2 hospices, b) successful utilization of an in-house developed C. auris real-time PCR assay for the rapid screening of patient and environmental surveillance samples, c) demonstration of relatively heavier colonization of C. auris in nares compared to the axilla/groin, and d) predominance of the South Asia Clade I with intrinsic resistance to fluconazole and elevated minimum inhibitory concentration (MIC) to voriconazole (81%), amphotericin B (61%), 5-FC (3%) and echinocandins (1%). These findings reflect greater regional prevalence and incidence of C. auris and the deployment of better detection tools in an unprecedented outbreak.

scholarly journals Development and Validation of a Real-Time PCR Assay for Rapid Detection of Candida auris from Surveillance Samples

2017 ◽  
Vol 56 (2) ◽  
Author(s):  
L. Leach ◽  
Y. Zhu ◽  
S. Chaturvedi
Keyword(s):  
Health Care ◽  
Real Time ◽  
Real Time Pcr ◽  
Multidrug Resistant ◽  
Effective Control ◽  
Pcr Assay ◽  
Candida Auris ◽  
Content Type ◽  
The Real ◽  
Positive Results

ABSTRACT Candida auris is an emerging multidrug-resistant yeast causing invasive health care-associated infection with high mortality worldwide. Rapid identification of C. auris is of primary importance for the implementation of public health measures to control the spread of infection. To achieve these goals, we developed and validated a TaqMan-based real-time PCR assay targeting the internal transcribed spacer 2 (ITS2) region of the ribosomal gene. The assay was highly specific, reproducible, and sensitive, with the detection limit of 1 C. auris CFU/PCR. The performance of the C. auris real-time PCR assay was evaluated by using 623 surveillance samples, including 365 patient swabs and 258 environmental sponges. Real-time PCR yielded positive results from 49 swab and 58 sponge samples, with 89% and 100% clinical sensitivity with regard to their respective culture-positive results. The real-time PCR also detected C. auris DNA from 1% and 12% of swab and sponge samples with culture-negative results, indicating the presence of dead or culture-impaired C. auris. The real-time PCR yielded results within 4 h of sample processing, compared to 4 to 14 days for culture, reducing turnaround time significantly. The new real-time PCR assay allows for accurate and rapid screening of C. auris and can increase effective control and prevention of this emerging multidrug-resistant fungal pathogen in health care facilities.

scholarly journals Analysis of a Candida auris Outbreak Provides New Insights into an Emerging Pathogen

2020 ◽  
Vol 58 (4) ◽  
Author(s):  
Brian L. Wickes
Keyword(s):  
Health Care ◽  
New York ◽  
Fungal Pathogen ◽  
Antifungal Susceptibility ◽  
Health Care Facilities ◽  
Diagnostic Methods ◽  
Candida Auris ◽  
Laboratory Findings ◽  
Content Type ◽  
Human Fungal Pathogen

ABSTRACT Candida auris is an emerging human fungal pathogen that is being increasingly linked to outbreaks. It is concerning to health care workers because of its high mortality rate, due primarily to its antifungal resistance. Among the tools being developed to study this yeast are large cohorts of regional isolates, which can be useful for studying epidemiology, antifungal susceptibility patterns, and diagnostic methods. In this issue of the Journal of Clinical Microbiology, Y. Zhu, B. O’Brien, L. Leach, A. Clarke, et al. (J Clin Microbiol 58:e01503-19, 2020, https://doi.org/10.1128/JCM.01503-19) describe the laboratory findings of a collection of isolates from a large outbreak of C. auris obtained from numerous health care facilities in the New York area. Real-time PCR was used as a screening tool with great accuracy, while internal transcribed spacer (ITS) and D1/D2 sequencing were successfully employed for isolate clade assignment. South Asia clade I was identified as the major genotype, while South American clade IV was a minor genotype. Surveillance isolates from patients confirmed axilla/groin and nare colonization; however, results of quantitative analysis of fungal burdens showed that when the nares are colonized, burdens are significantly higher than for axilla/groin colonization. Antifungal susceptibility testing was in agreement with past studies. High levels of fluconazole resistance were detected, while few isolates were resistant to echinocandins. Resistance to multiple antifungals was frequent, and three isolates were recovered that appeared to be pan-resistant. This type of study is yet another useful tool for investigating C. auris, which is becoming an increasingly important human fungal pathogen that should be monitored very closely.

scholarly journals Transcriptional Profiling of the Candida auris Response to Exogenous Farnesol Exposure

mSphere ◽  
2021 ◽  
Author(s):  
Ágnes Jakab ◽  
Noémi Balla ◽  
Ágota Ragyák ◽  
Fruzsina Nagy ◽  
Fruzsina Kovács ◽  
...  
Keyword(s):  
Health Care ◽  
Mortality Rate ◽  
Fungal Pathogen ◽  
Transcriptional Profiling ◽  
Health Care Facilities ◽  
Antifungal Drugs ◽  
Candida Auris ◽  
Content Type ◽  
Care Facilities ◽  
Innovative Therapies

Candida auris is a dangerous fungal pathogen that causes outbreaks in health care facilities, with infections associated with a high mortality rate. As conventional antifungal drugs have limited effects against the majority of clinical isolates, new and innovative therapies are urgently needed.

scholarly journals Candida auris Biofilm Colonization on Skin Niche Conditions

mSphere ◽  
2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Priya Uppuluri
Keyword(s):  
Health Care ◽  
Ex Vivo ◽  
Multidrug Resistant ◽  
Health Care Facilities ◽  
Candida Auris ◽  
Biofilm Growth ◽  
Content Type ◽  
Care Facilities ◽  
Invasive Infections ◽  
Skin Conditions

ABSTRACT Candida auris, an emerging multidrug-resistant yeast, has recently been associated with outbreaks of invasive infections in health care facilities worldwide. Its success as a nosocomial pathogen lies in its capability to sustain for prolonged periods in the intensive care unit (ICU), adeptly colonize skin, and spread among patients. Little is known of the mechanism behind the predilection of C. auris for skin or the extent of its resilience on it. Now, M. V. Horton, C. J. Johnson, J. F. Kernien, T. D. Patel, et al. (mSphere 5:e00910-19, 2020, https://doi.org/10.1128/mSphere.00910-19) demonstrate that in synthetic sweat medium designed to mimic axillary skin conditions, C. auris can grow into multilayers of cells called biofilms that can resist desiccation. C. auris’ propensity to form biofilms was further elaborated using a novel ex vivo porcine skin model of skin colonization. These studies provide early evidence that C. auris biofilm cells persisting on skin could serve as source of continuing outbreaks in health care facilities. Interventions blocking C. auris biofilm growth on skin will help control the spread of this pathogen.

Patient satisfaction with the quality of care in Ghana’s health-care institutions

2019 ◽  
Vol 13 (2) ◽  
pp. 160-170 ◽  
Author(s):  
Aaron Asibi Abuosi ◽  
Mahama Braimah
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Service Delivery ◽  
National Survey ◽  
Health Care Facilities ◽  
Health Facilities ◽  
Content Type ◽  
Care Facilities

Purpose The purpose of this study was to examine patient satisfaction with the quality of care in Ghana’s health-care facilities using a disaggregated approach. Design/methodology/approach The study was a cross-sectional national survey. A sample of 4,079 males and females in the age group of 15-49 years were interviewed. Descriptive statistics, principal component analysis and t-tests were used in statistical analysis. Findings About 70 per cent of patients were satisfied with the quality of care provided in health-care facilities in Ghana, whereas about 30 per cent of patients were fairly satisfied. Females and insured patients were more likely to be satisfied with the quality of care, compared with males and uninsured patients. Research limitations/implications Because data were obtained from a national survey, the questionnaire did not include the type of facility patients attended to find out whether satisfaction with the quality of care varied by the type of health facility. Future studies may, therefore, include this. Practical implications The study contributes to the literature on patient satisfaction with the quality of care. It highlights that long waiting time remains an intractable problem at various service delivery units of health facilities and constitutes a major source of patient dissatisfaction with the quality of care. Innovative measures must, therefore, be adopted to address the problem. Originality/value There is a paucity of research that uses a disaggregated approach to examine patient satisfaction with the quality of care at various service delivery units of health facilities. This study is a modest contribution to this research gap.

Indoor air in healing environments

Facilities ◽  
2019 ◽  
Vol 37 (9/10) ◽  
pp. 600-623 ◽  
Author(s):  
Marco Gola ◽  
Gaetano Settimo ◽  
Stefano Capolongo
Keyword(s):  
Health Care ◽  
Air Quality ◽  
Indoor Air ◽  
Management Strategies ◽  
Health Care Facilities ◽  
Chemical Pollution ◽  
Content Type ◽  
Starting Point ◽  
Care Facilities ◽  
Maintenance Activities

Purpose Several countries have carried out air quality monitoring in professional workplaces where chemicals are used. Health-care spaces have been less investigated. This paper aims to define a protocol, as developed by a research group, for inpatient rooms to understand the state of the art and to suggest design and management strategies for improving process quality. Design/methodology/approach Starting from the ISO-16000 standard and guidelines for monitoring activities, a protocol is defined for a one year investigation, with passive samplers. Through data analysis of the investigations and analysis of the cleaning and finishing products, heating, ventilation and air conditioning and maintenance activities, etc., it is possible to highlight the potential influences of chemical pollution. Findings A methodology is defined for understanding the chemical pollution and the possible factors related to construction materials, cleaning products and maintenance activities. Research limitations/implications The paper analyzes only a limited number of case studies because the monitoring activity is still in progress. Practical implications The investigation offers a starting point for a wide tool for the definition of design, maintenance and management strategies in health-care facilities. Social implications The research project, aimed at improving the knowledge of indoor air quality (IAQ) in inpatient rooms, is a starting point for a supporting tool for future regulations concerning health-care facilities. Originality/value IAQ is an issue on which many governments are focusing. Several health-care researchers have reported studies that aim at improving users’ health. Most investigations are about biological and physical risks, but chemical risks have been less studied. The paper suggests some design and management strategies for inpatient room.

Confidentiality and security of information in the public health-care facilities to curb HIV/AIDS trauma among patients in Africa

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ngoako Solomon Marutha ◽  
Olefhile Mosweu
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Facilities ◽  
Public Health Care ◽  
Chronic Patients ◽  
Aids Patients ◽  
Content Type ◽  
The Public ◽  
Care Facilities ◽  
Hiv Aids

Purpose This study sought to investigate a framework for ensuring the confidentiality and security of information at the public health-care facilities to curb HIV/AIDS trauma among patients in Africa. In most instances, trauma to HIV/AIDS patients accelerate because of their personal information relating to the state of illness leaks to public people. Design/methodology/approach This qualitative study used literature to study confidentiality and security of information at the public health-care facilities to curb HIV/AIDS trauma among patients in Africa. Findings The study revealed that confidentiality and security of information has been neglected, in most instances, at the health-care facilities, and this has, to some extent, affected HIV/AIDS patients negatively, leading to trauma, stigma and skipping of treatment by patients resulting in accelerated mortality among chronic patients. The study recommends that patients’ information be always strictly controlled and kept confidential and secured at all the times, especially that of HIV/AIDS patients. Practical implications The proposed framework can be used by health-care facilities to guide the management and promotion of the confidentiality and security of information in the public health-care facilities to curb additional trauma to HIV/AIDS patients in the context of Africa, and even beyond. Originality/value The study provides a framework to ensure the confidentiality and security of information at the public health-care facilities to curb additional trauma to HIV/AIDS patients.

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