ID Week 2018 as seen by an Infection Preventionist

Guest Blogger Barley Chironda (bio below) writes…

IDWeek was held this year from Oct 3 to 7, 2018 in beautiful San Francisco. This was my fourth year in a row attending; having first attended and blogged about my first experience here in 2014. The pressure to offer IDWeek attendees a stellar conference was palpable. A week before, the city of San Francisco had hosted Dream Force. Dream Force is one of the world’s largest tech conventions with over 150,000 attendees. I’m glad to say IDWeek did not disappoint; boasting it’s highest ever attendance of over 8,000 people from over 85 countries. Given its wide and diverse audience, there are many targeted streams that allow a range of topics.

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Reflections from FIS/HIS 2016: Cauliflower, Clostridium, cash, and Candida

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A very enjoyable few days in Edinburgh this week for the Federation of Infection Societies / Healthcare Infections Society (FIS/HIS) meeting. Some reflections follow…

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Tired of MRSA and CPE? The new superbug has arrived and it’s a yeast!

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All of a sudden, Candida auris seems to become the “new” global super villain.  Antimicrobial Resistance and Infection Control recently published the first, large European outbreak of C. auris in London with 50 cases (Schelenz et al.) and CDC just published the first 17 US cases (Vallabhaneni et al.).  While I believe that C. auris deserves our full attention, as it is a multi-resistant yeast, with increased MICs to all three major classes of antifungals, likes to evades traditional diagnostic methods, seems to be difficult to eradicate from the hospital environment, and causes invasive nosocomial infections with high mortality, I am still amazed by the fact that – despite the global society we live in – this “new” villain first has to come to Europe or even more important the US, before becoming a recognized “superbug”.

C. auris was first described in 2009 in Japan and cases of candidemia have since been reported from South Korea, India, South Africa, and Kuwait, in addition to unpublished reports from Colombia, Venezuela, and Pakistan. While “global migration” may come to mind for the rise of C. auris, it seems unlikely, as different continents and countries seem to have their own clones. Selection pressure due to the increasing use of antifungals in healthcare, livestock, and agriculture might be a more feasable explanation, but the true reasons for the recent emergence are still unknown.

I assume that many countries will issue guidelines with regard to diagnostic methods, reporting to health authorities, environmental cleaning and infection control, but as that might take time, those of us in infection control should get prepared and stay informed, not to be surprised to see C. auris emerging within their own setting.

Literature and links

Schelenz et al. First hospital outbreak of the globally emerging Candida auris in a European hospital, Antimicrobial Resistance & Infection Control20165:35
Chowdhary et al.  Multidrug resistant Candida auris: New kid on the block in hospital associated infections? Journal of Hospital Infection August 2016,  DOI: 10.1016/j.jhin.2016.08.004
Satoh et al., Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol, 2009;53:41-44
Lee et al., First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol, 2011;49:3139-42.
Chowdhary et al. New clonal strain of Candida auris, Delhi, India. Emerg Infect Dis, 2013; 19:1670-73.
CDC Q&A

Excluding Funguria from CAUTI or “How to effortlessly reduce HAI-rates”

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According to Dicks et al. (ICHE 2015;36:467-9) the presence of fungi in urine rarely represents true infection. The authors state, that excluding yeast from catheter-associated UTI surveillance definition reduced CAUTI-rates by 25% in community hospitals and at tertiary-care medical center.

While I agree, that in many instances candiduria represents colonization or contamination of the specimen and not invasive candidiasis, and that not all cases of candiduria need treatment, they all warrant a clinical evaluation. In my Iowa years (1992/93) Dick Wenzel, Mike Pfaller and other established the importance of yeast in HAI’s, Pittet and others developed indices to better detect patients with candidemia, and my own research showed that candida in urine was one of the most important warning signs in patients suspected for candidemia. Once excluded from surveillance definitions, will our colleagues still see the importance of this occurrence? True, fungi in urine not always represents true infection, but frequently are a warning sign.  I am not sure about the need to change CAUTI definitions, or why one would stop at fungi for exclusion, but in general believe that we should leave our definitions as stable as possible.