M1. Clinical studies of fungal infections
Oral Abstract Submission
Mary K. Hayden, MD
Chief, Division of Infectious Diseases; Director, Division of Clinical Microbiology, Professor of Medicine and Pathology
Rush University Medical Center
Chicago, Illinois
Disclosure: Clorox: Grant/Research Support, Other Financial or Material Support, I am co-investigator on research projects at healthcare facilities where Clorox provides product at no cost. Neither I nor my institution receive product.
Medline: Other Financial or Material Support, I am co-investigator on research projects at healthcare facilities where Medline provides product at no cost. Neither I nor my institution receive product.
Molnlycke: Other Financial or Material Support, I am co-investigator on research projects at healthcare facilities where Molnlycke provides product at no cost. Neither I nor my institution receive product.
OpGen: Other Financial or Material Support, I am co-investigator on research projects at healthcare facilities where Sage provides laboratory services at no cost. Neither I nor my institution receive services.
Sage: Other Financial or Material Support, I am co-investigator on research projects at healthcare facilities where Sage provides product at no cost. Neither I nor my institution receive product.
Thelma E. Dangana, MBBS
Coordinator
Rush University Medical Center
Chicago, IL
Disclosure: Nothing to disclose
Michael Schoeny, PhD
Associate Professor
Rush University Medical Center
Chicago, IL
Disclosure: Nothing to disclose
Pamela B. Bell, II, BA
Lab Research Tech III
Rush University Medical Center
Chicago, IL
Disclosure: Nothing to disclose
Mary Stanley, MS
Research Lab Tech III
Rush University Medical Center
Chicago, IL
Disclosure: Nothing to disclose
Nailliw Preite, MS
Research Laboratory Supervisor
Rush University Medical Center
Chicago, IL
Disclosure: Nothing to disclose
Nadia Khan, BS
Research Lab Tech 1
Rush University Medical Center
Chicago, IL
Disclosure: Nothing to disclose
Osayuwamen Edomwande, BS
Research Lab Tech 1
Rush University Medical Center
Chicago, IL
Disclosure: Nothing to disclose
Stephanie R. Black, MD, MSc
Medical Director, Communicable Diseases Program
Chicago Department of Public Health
Chicago, IL
Disclosure: Nothing to disclose
Massimo Pacilli, MS, MPH
Manager of Quality Assurance, Laboratory Liaison
Chicago Department of Public Health
Chicago, IL
Disclosure: Nothing to disclose
Xin Huang, PhD
Post-doctoral research fellow
National Institutes of Health
Bethesda, MD
Disclosure: Nothing to disclose
Clay Deming, MS
Research technician
National Institutes of Health
Bethesda, MD
Disclosure: Nothing to disclose
Michael Y. Lin, MD, MPH
Associate Professor
Rush University Medical Center
Chicago, IL
Disclosure: CareFusion Foundation (BD): Investigator-initiated grant, Other Financial or Material Support
OpGen: Other Financial or Material Support, Research support in the form of contributed product
Sage Products (now part of Stryker): Other Financial or Material Support, Research support in the form of contributed product
Julia A. Segre, PhD
Senior Investigator, Microbial Genomics Section; Chief, Translational and Functional Genomics Branch
National Institutes of Health
Bethesda, MD
Disclosure: Nothing to disclose
Background :
vSNF patients are at high risk of colonization and infection with C. auris. CHG bathing has been used as an intervention to reduce nosocomial transmission of multidrug-resistant organisms, but its effect on C. auris is unclear.
Methods :
We studied a 70-bed ventilator ward in a 300-bed vSNF in Chicago, IL with high prevalence of C. auris and established CHG bathing. Swab samples were collected from patients for culture, microbiome analysis, and CHG skin concentration testing (Table 1).
Results :
We collected 2,467 samples (950 culture, 950 microbiome, 567 CHG) from 57 patients during 2 surveys conducted Jan-Mar 2019. 46 (81%) patients had C. auris cultured from ≥ 1 body site. Mean (± SD) age was 59 (± 14) yrs, 40% were women, 70% were African American, mean (± SD) Charlson score was 3 (± 2). Patients colonized with C. auris were more likely to be mechanically ventilated (50% vs 0%, p < 0.001), have a gastrostomy tube (78% vs 27%, P < 0.001) or have urinary catheter (72% vs. 23%, p = 0.01) than non-colonized patients. Frequency of C. auris isolation varied among 10 body sites tested (P < 0.001); colonization of anterior nares (41%) and hands (40%) was detected most often (Figure 1).
By ITS1 analysis, all isolates were members of the C. auris South American clade. Skin microbiome sequencing confirmed culture results. While Malassezia is the dominant genera observed in healthy volunteers and patients in this vSNF, C. auris was observed to dominate the fungal community of multiple skin sites, including nares, hands, inguinal, toe web (Figure 2). Other Candida spp. were also identified on skin of patients in the current study, but at lower relative abundance.
CHG was detected on skin of 52 (91%) patients (median CHG concentration 19.5 µg/mL; IQR 4.9 – 78.1 µg/mL). In a mixed effects model controlling for body site and multiple measurements per patient, odds of C. auris detection by culture were less at CHG concentrations ≥ 625 µg/mL than at lower concentrations (Figure 3; OR 0.25, 95% CI: 0.10-0.66; P = 0.005).
Conclusion :
Frequent C. auris colonization of vSNF patients’ anterior nares and hands suggests that nasal decolonization and patient hand hygiene are potential options to reduce C. auris transmission. High concentrations of CHG may be needed to suppress C. auris on skin.
