Introduction 

On March 20, 2023, the Centers for Disease Control and Prevention (CDC) issued a press release describing the increased spread of Candida auris (C. auris) in U.S. health care facilities. The CDC also noted a tripling in the number of cases in 2021 that were resistant to echinocandins, the antifungal most frequently used for treatment of C. auris.

Since C. auris was first detected in the United States in 2016, cases have continued to rise each year, with the most rapid rise being from 2020–2021. Cases have now been reported in 27 states, including Wisconsin.

C. auris case counts may have increased for several reasons, including infection prevention and control challenges during the pandemic as well as enhanced efforts to detect cases.

Background

C. auris is a fungus that is often resistant to multiple antifungal drugs. It spreads easily, especially in health care settings and can cause severe infections, even death. While an increase in C. auris cases is concerning, the disease is not generally a threat to healthy people. Those most at risk for acquiring C. auris include individuals who:

• Are already severely ill.
• Have invasive medical devices.
• Have frequent or lengthy stays in health care facilities.

Wisconsin cases

Seven C. auris cases have been detected in Wisconsin since the first case was identified in January 2022. All seven Wisconsin cases were detected in the Southeastern public health region. Three cases were clinical cases, meaning causing an active infection. In the other four cases, the individual was colonized with C. auris, meaning C. auris was detected on the body but was not causing an active infection. Most of these cases also had links to health care in other states or countries where C. auris is known to have a presence.

The Wisconsin State Laboratory of Hygiene (WSLH) serves as the CDC-funded Midwest Antimicrobial Resistance Lab Network laboratory and has been on the forefront of testing and surveillance. Confirmatory testing to identify C. auris is primarily done by WSLH and all identified cases are automatically reported to the Wisconsin Electronic Disease Surveillance System. The Wisconsin Healthcare-Associated Infections (HAI) Prevention Program and local or Tribal health departments follow up on all positive cases and provide education and assistance to facilities.

Recommendations

C. auris has been an officially reportable communicable disease condition in Wisconsin since July 2022. This active tracking of cases provides systematic awareness of C. auris statewide and forms the basis for public health follow up. The Department of Health Services (DHS) recommends that health care facilities implement the actions below to prevent and control C. auris in Wisconsin:

Infection prevention and control best practices

Follow CDC’s core infection prevention practices for safe care delivery, including thorough hand hygiene; appropriate use of personal protective equipment; staff, patient, and resident education; practice adherence monitoring; and implementation of enhanced barrier precautions in nursing homes, which are specifically aimed at preventing transmission of organisms like C. auris. 

Transfer communication

Prioritize communication about patient and resident multidrug-resistant organism (MDRO) histories with all facility transfer communications to ensure individuals with a known C. auris history are proactively put into transmission-based precautions.

Cleaning and disinfection

• Ensure thorough cleaning and disinfection, including daily and terminal cleaning, of the care environment per the labeled instructions using a disinfectant on Environmental Protection Agency List P, which shows efficacy against C. auris.
• Perform proper cleaning and disinfection of shared medical equipment per the manufacturer’s instructions for use.

Guidance and support

• Consider proactive screening in higher-risk settings such as long-term acute care hospitals, ventilator equipped skilled nursing facilities, facilities with known C. auris cases, and facilities taking admissions from areas with higher disease prevalence. Facilities can work with the HAI Prevention Program (DHSWIHAIPreventionProgram@dhs.wisconsin.gov) to develop a testing strategy based on their risks and patient or resident population.
• Connect with your HAI Prevention Program Regional Infection Preventionist to discuss having an educational infection control assessment and other prevention-focused recommendations.

DHS Resources

• Healthcare-Associated Infections: Reportable Multidrug-Resistant Organisms
• Candida auris: Factsheet for Health Care Settings
• Recommendations for Prevention and Control of Targeted Multidrug-Resistant Organisms in Wisconsin Nursing Homes
• Guidelines for Prevention and Control of Multidrug-Resistant Organisms for Health Care Settings

Questions?

For questions, please reach out to the HAI Prevention Program (DHSWIHAIPreventionProgram@dhs.wisconsin.gov).