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Cited by 125Antifungal resistance and susceptibilityInfection Control in HealthcareNosocomial Infections in ICU

Factors Associated With Candida auris Colonization and Transmission in Skilled Nursing Facilities With Ventilator Units, New York, 2016–2018

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Rossow, John, Ostrowsky, Belinda, Adams, Eleanor, Greenko, Jane, McDonald, Robert, Vallabhaneni, Snigdha, Forsberg, Kaitlin, Perez, Stephen +17 more·2021·Clinical Infectious Diseases
DOI 10.1093/cid/ciaa1462PMC PMC8155826
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Abstract

Background: Candida auris is an emerging, multidrug-resistant yeast that spreads in healthcare settings. People colonized with C. auris can transmit this pathogen and are at risk for invasive infections. New York State (NYS) has the largest US burden (>500 colonized and infected people); many colonized individuals are mechanically ventilated or have tracheostomy, and are residents of ventilator-capable skilled nursing facilities (vSNF). We evaluated the factors associated with C. auris colonization among vSNF residents to inform prevention interventions. Methods: During 2016–2018, the NYS Department of Health conducted point prevalence surveys (PPS) to detect C. auris colonization among residents of vSNFs. In a case-control investigation, we defined a case as C. auris colonization in a resident, and identified up to 4 residents with negative swabs during the same PPS as controls. We abstracted data from medical records on patient facility transfers, antimicrobial use, and medical history. Results: We included 60 cases and 218 controls identified from 6 vSNFs. After controlling for potential confounders, the following characteristics were associated with C. auris colonization: being on a ventilator (adjusted odds ratio [aOR], 5.9; 95% confidence interval [CI], 2.3–15.4), receiving carbapenem antibiotics in the prior 90 days (aOR, 3.5; 95% CI, 1.6–7.6), having ≥1 acute care hospital visit in the prior 6 months (aOR, 4.2; 95% CI, 1.9–9.6), and receiving systemic fluconazole in the prior 90 days (aOR, 6.0; 95% CI, 1.6–22.6). Conclusions: Targeted screening of patients in vSNFs with the above risk factors for C. auris can help identify colonized patients and facilitate the implementation of infection control measures. Antimicrobial stewardship may be an important factor in the prevention of C. auris colonization.

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  • Additional clinical conditions associated with C. auris colonization and/or systemic infection include chronic kidney disease, hemodialysis, malignancy, central venous or urinary catheterization, and total parenteral nutrition, mirroring known risk factors for infections by other Candida species.

    “Additional clinical conditions associated with C. auris colonization and/or systemic infection include chronic kidney disease, hemodialysis, malignancy, central venous or urinary catheterization, and total parenteral nutrition, mirroring known risk factors for infections by other Candida species [45,46,59].”

    From Host–Candida auris interactions in the skin (2026) · cites this paper as [45]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • 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 [66]

    The Results (page unavailable) associate a recent acute-care hospital visit with C. auris colonization among ventilator-skilled-nursing-facility residents, and the Discussion describes LTACH populations as high-yield for detection. The study used skin-site swabs, but it did not establish that longer hospital stays increased colonization risk or directly test that association in LTACH patients. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Prior use of antifungals such as fluconazole has been associated with an increased risk for C. auris skin colonization and infection, representing 11.7% of the cases and 65.2% of the invasive infections in humans.

    “Prior use of antifungals such as fluconazole has been associated with an increased risk for C. auris skin colonization and infection, which represented 11.7% of the cases [45] and 65.2% of the invasive infections in humans [53].”

    From Host–Candida auris interactions in the skin (2026) · cites this paper as [45]

    The Results report that fluconazole use in the prior 90 days was associated with C. auris colonization in skilled nursing facility residents, and that 11.7% of colonized cases had received fluconazole. The paper does not establish an association between prior fluconazole use and invasive infection. The 65.2% figure is attached to a different citation in the citing sentence. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • C. auris skin colonization frequently occurs in patients recently exposed to prolonged courses of broad-spectrum antibiotics, particularly carbapenems and vancomycin, with 43.3% of colonized patients treated with carbapenems, and 41.7% with vancomycin.

    “C. auris skin colonization frequently occurs in patients recently exposed to prolonged courses of broad-spectrum antibiotics, particularly carbapenems and vancomycin, with 43.3% of colonized patients treated with carbapenems, and 41.7% with vancomycin [40–43,45–47].”

    From Host–Candida auris interactions in the skin (2026) · cites this paper as [45]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • Candida auris can persistently colonize human skin.

    “C. auris exhibits a particular tropism for the skin6–8. It is capable of persistent colonization in niches such as the axillae and groin”

    From The Wor2 phenotypic switching regulator controls biofilm formation in Candida auris (2026) · cites this paper as [7]

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Cites

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Cited by

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Authors
Rossow, J., Ostrowsky, B., Adams, E., Greenko, J., McDonald, R., Vallabhaneni, S., Forsberg, K., Perez, S., Lucas, T., Alroy, K. A., Jacobs Slifka, K., Walters, M., Jackson, B. R., Quinn, M., Chaturvedi, S., Blog, D., Workgroup, N. Y. C. A. I., Southwick, K., Denis, R. J., Erazo, R., Fernandez, R., Bucher, C., Leach, L., Zhu, Y., & Lutterloh, E.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • New York State Department of Health (US)
  • Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  • Wadsworth Center (US)
Corresponding author
Rossow, John
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2020-09-28
Volume
72
Issue
11
Pages
e753-e760
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1093/cid/ciaa1462
PMC
PMC8155826
OpenAlex
W3088948418
Cited by
125
References
2
Citations by year
2026: 24 · 2025: 29 · 2024: 25 · 2023: 24 · 2022: 9 · 2021: 14
FWCI
1.61
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • Clinical Infectious Diseases (publishedVersion, public-domain)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Centers for Disease Control and Prevention (CK14-1401, NU50CK000423)
  • National Institutes of Health
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, fungal colonization, skilled nursing facilities, mechanical ventilation, carbapenem exposure, fluconazole, antimicrobial stewardship, risk factors, infection transmission, point prevalence survey, infection control, New York State
MeSH terms
Antifungal Agents, Candida, Humans, New York, Ventilators, Mechanical, Skilled Nursing Facilities, Fluconazole

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