2483. Rise in inpatient Candida auris cases at a tertiary hospital in Washington, DC during the COVID-19 pandemic
Authors: Seeger Daniel , Spence Matthew , Siegel Marc O , Palmore Tara , Demessie Gizachew , Flores Irvin Ibarra , Bard Jennifer Dien , Morgan Margie Ann , Contreras Deisy , Lucar Jose , Yee Rebecca 
Published: November 2023

Abstract

Background
Candida auris is deemed an urgent threat because it spreads easily in healthcare facilities, can cause severe infections with high mortality rates, and is resistant to antifungal agents. Since the onset of the COVID-19 pandemic, we detected a rise in inpatient C. auris cases. We describe a series of C. auris cases at a tertiary hospital in Washington, DC.
Cases of Candida auris by date of initial sample collection, GW Hospital, Washington, DC, March 2020 - April 2023.

Methods
We reviewed charts of inpatients with C. auris between 3/2020-4/2023. Patients transferred from a single long-term care acute hospital (LTACH) with high C. auris prevalence were placed in empiric isolation on admission and screened for C. auris colonization via axilla and groin surveillance swabs. C. auris was identified by MALDI-TOF MS and/or Biofire BCID Panel v2 and strain typing was performed by Fourier-Transform Infrared Spectroscopy. Antifungal susceptibility testing (AST) was performed via broth microdilution and interpreted using tentative breakpoints from CDC.

Results
We identified 41 cases of C. auris (median age 62, 66% males). 29 patients (71%) were transferred from the LTACH. 29 (71%) patients had either a tracheostomy or gastrostomy tube. 22 (54%) were identified through surveillance culture (21 from the LTACH) and 19 (46%) via clinical culture (blood=9, urine=7, wound=2, respiratory=1). 2/32 (6%) patients with C. auris detected initially via non-blood specimens later developed C. auris candidemia. 8/11 (73%) cases of candidemia were CLABSIs. Overall, 8/41 (20%) patients either died or were placed on comfort care during hospitalization. Among 23 isolates available for AST, 22 (96%) were resistant to fluconazole, 15 (65%) to amphotericin B, and 1 (4%) to anidulafungin. Preliminary strain typing suggested grouping of isolates into 2 main clusters denoting distribution into 2 distinct clades; further characterization is undergoing.

Conclusion
The COVID-19 pandemic placed healthcare systems under unprecedented strain which has accelerated the spread of antimicrobial resistant pathogens. The finding that 1 of 5 patients with C. auris infection or colonization died/were placed on comfort care underscores the poor prognosis associated with C. auris. To combat the spread of C. auris, further development of antifungals, rapid diagnostics, and effective infection prevention strategies are needed.

Disclosures
Tara Palmore, MD, Abbvie: Grant/Research Support|Gilead: Grant/Research Support|Rigel: Grant/Research Support Jennifer Dien Bard, PhD, Abbott Molecular: Grant/Research Support|BioMerieux: Advisor/Consultant|BioMerieux: Grant/Research Support|BioMerieux: Honoraria|Genetic Signature: Advisor/Consultant|Genetic Signature: Grant/Research Support|Luminex: Grant/Research Support|Salve: Stocks/Bonds|Thermo Fisher: Honoraria