A Candida auris Outbreak and Its Control in an Intensive Care Setting
Abstract
BACKGROUND: Candida auris is an emerging and multidrug-resistant pathogen. Here we report the epidemiology of a hospital outbreak of C. auris colonization and infection. METHODS: After identification of a cluster of C. auris infections in the neurosciences intensive care unit (ICU) of the Oxford University Hospitals, United Kingdom, we instituted an intensive patient and environmental screening program and package of interventions. Multivariable logistic regression was used to identify predictors of C. auris colonization and infection. Isolates from patients and from the environment were analyzed by whole-genome sequencing. RESULTS: A total of 70 patients were identified as being colonized or infected with C. auris between February 2, 2015, and August 31, 2017; of these patients, 66 (94%) had been admitted to the neurosciences ICU before diagnosis. Invasive C. auris infections developed in 7 patients. When length of stay in the neurosciences ICU and patient vital signs and laboratory results were controlled for, the predictors of C. auris colonization or infection included the use of reusable skin-surface axillary temperature probes (multivariable odds ratio, 6.80; 95% confidence interval [CI], 2.96 to 15.63; P<0.001) and systemic fluconazole exposure (multivariable odds ratio, 10.34; 95% CI, 1.64 to 65.18; P=0.01). C. auris was rarely detected in the general environment. However, it was detected in isolates from reusable equipment, including multiple axillary skin-surface temperature probes. Despite a bundle of infection-control interventions, the incidence of new cases was reduced only after removal of the temperature probes. All outbreak sequences formed a single genetic cluster within the C. auris South African clade. The sequenced isolates from reusable equipment were genetically related to isolates from the patients. CONCLUSIONS: The transmission of C. auris in this hospital outbreak was found to be linked to reusable axillary temperature probes, indicating that this emerging pathogen can persist in the environment and be transmitted in health care settings. (Funded by the National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Oxford University and others.).
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A C. auris outbreak in the United Kingdom was linked to the use of reusable axillary temperature probes.
“As an example, a C. auris outbreak in the United Kingdom was linked to the use of reusable axillary temperature probes (20).”
From Candida auris Forms High-Burden Biofilms in Skin Niche Conditions and on Porcine Skin (2020) · cites this paper as [20]
C. auris is an emerging fungal species responsible for healthcare-associated outbreaks and infections associated with relatively poor patient outcomes.
“Candida auris is an emerging fungal species responsible for healthcare-associated outbreaks and infections associated with relatively poor patient outcomes (1–6).”
From Dual function of <i>Candida auris</i> mannosyltransferase, MNT5, in biofilm community protection from antifungal therapy and the host (2025) · cites this paper as [5]
C. auris persistently colonizes patient skin and adheres to abiotic surfaces, creating reservoirs that enable prolonged transmission in healthcare settings.
“These outbreaks are marked by the pathogen’s ability to persistently colonize patient skin and adhere to abiotic surfaces, creating reservoirs that enable prolonged transmission within healthcare settings9–15.”
From Adhesin Als4112 promotes Candida auris skin colonization through interactions with keratinocytes and extracellular matrix proteins (2025) · cites this paper as [14]
Patients with long-term hospital stays, especially those in long-term acute care hospitals (LTACHs), were found to be likely to have C. auris skin colonization.
“As a result, patients with long-term hospital stays, especially those in long-term acute care hospitals (LTACHs) [66,67], were found to be likely to have C. auris skin colonization.”
From Host–Candida auris interactions in the skin (2026) · cites this paper as [67]
A skin tissue reservoir for C. auris may exist in humans, as in mice.
“A previous clinical study had similarly observed the re-emergence of C. auris on patient skin after three consecutive negative culture screens (Eyre et al., 2018), suggesting that a skin tissue reservoir for C. auris may exist in humans, as in mice.”
From Murine model of colonization with fungal pathogen Candida auris to explore skin tropism, host risk factors and therapeutic strategies (2021) · cites this paper as Eyre et al., 2018
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- Authors
- Eyre, D. W., Sheppard, A. E., Madder, H., Moir, I., Moroney, R., Quan, T. P., Griffiths, D., George, S., Butcher, L., Morgan, M., Newnham, R., Sunderland, M., Clarke, T., Foster, D., Hoffman, P., Borman, A. M., Johnson, E. M., Moore, G., Brown, C. S., Walker, A. S., Peto, T. E. A., Crook, D. W., & Jeffery, K. J. M.
- Affiliations
- National Institute for Health and Care Research (GB)
- Oxford University Hospitals NHS Trust (GB)
- Public Health England (GB)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2018-10-04
- Volume
- 379
- Issue
- 14
- Pages
- 1322-1331
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2895137000
- Cited by
- 517
- References
- 2
- Citations by year
- 2026: 68 · 2025: 60 · 2024: 63 · 2023: 55 · 2022: 53 · 2021: 63 · 2020: 81 · 2019: 69 · 2018: 5
- FWCI
- 41.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health Research (Health Protection Research Unit (NIHR HPRU) in Hea)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- Candida auris, hospital outbreak, intensive care unit, nosocomial infections, environmental transmission, reusable medical devices, fluconazole, infection control interventions, environmental screening, multidrug resistance, neurosurgery
- MeSH terms
- Adult, Candida, Candidiasis, Cross Infection, Disease Outbreaks, Equipment Contamination, Female, United Kingdom, Hospital Departments, Humans, Intensive Care Units, Male, Microbial Sensitivity Tests, Middle Aged, Neurology, Phylogeny, Risk Factors, Thermometers, Incidence, Multivariate Analysis, Case-Control Studies, Infection Control, Equipment Reuse
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