Candida auris is reportable nationwide this year, a move that should boost surveillance of an emerging pathogen that has been primarily confined in three states: New York, New Jersey, and Illinois.

The decision by the Council of State and Territorial Epidemiologists (CSTE) should put C. auris prevalence in better focus, allowing better tracking and benchmarking to measure prevention efforts. Below are some highlights and provisions from the CSTE report, which is available at: https://bit.ly/2FUtEoy.

• “Laboratories should report suspected or confirmed cases of C. auris to State and Local Territorial [STLT] public health agencies and submit suspect C. auris isolates to regional Antibiotic Resistance Laboratory Network (AR Lab Network) laboratories or CDC via state public health laboratories for further characterization. Clinicians and healthcare facilities that become aware of a confirmed or potential case of C. auris should report the case to STLT public health authorities.”
• “Clinical manifestation of C. auris infection depends upon the site of infection. Patients with C. auris bloodstream infection typically have sepsis and severe illness. Other invasive infections, such as intra-abdominal candidiasis, can also occur. C. auris has also been found to cause wound infections and otitis. C. auris has been found in urine and respiratory specimens, though its contribution to clinical disease in these sites is unclear. C. auris also can colonize the skin, nose, ears, and other body sites of asymptomatic people.”

The following factors referenced in the CSTE report are aimed at helping to identify “epidemiologic linkage” in patients:

• “Person resided within the same household with another person with confirmatory or presumptive laboratory evidence of C. auris infection or colonization.
• OR person received care within the same healthcare facility as another person with confirmatory or presumptive laboratory evidence of C. auris infection or colonization.
• OR person received care in a healthcare facility that commonly shares patients with another facility that had a patient with confirmatory or presumptive laboratory evidence of C. auris infection or colonization.
• OR person had an overnight stay in a healthcare facility in the previous one year in a foreign country with documented C. auris transmission.”

The CSTE report also details the different classifications for clinical C. auris cases:

“Confirmed: Person with confirmatory laboratory evidence from a clinical specimen collected for the purpose of diagnosing or treating disease in the normal course of care. This includes specimens from sites reflecting invasive infection (e.g., blood, cerebrospinal fluid) and specimens from noninvasive sites such as wounds, urine, and the respiratory tract, where presence of C. auris may simply represent colonization and not true infection.

Probable: Person with presumptive laboratory evidence and evidence of epidemiologic linkage.

Suspect: Person with presumptive laboratory evidence and no evidence of epidemiologic linkage. Public health jurisdiction may consider stratifying clinical cases as invasive vs. noninvasive.”

REFERENCE

1. CSTE. Standardized Case Definition for Candida auris clinical and colonization/screening cases and National Notification of C. auris case, clinical 18-ID-05. Available at: https://bit.ly/2FUtEoy.