Regional Emergence of Candida auris in Chicago and Lessons Learned From Intensive Follow-up at 1 Ventilator-Capable Skilled Nursing Facility
Open accessAbstract
Background: Since the identification of the first 2 Candida auris cases in Chicago, Illinois, in 2016, ongoing spread has been documented in the Chicago area. We describe C. auris emergence in high-acuity, long-term healthcare facilities and present a case study of public health response to C. auris and carbapenemase-producing organisms (CPOs) at one ventilator-capable skilled nursing facility (vSNF-A). Methods: We performed point prevalence surveys (PPSs) to identify patients colonized with C. auris and infection-control (IC) assessments and provided ongoing support for IC improvements in Illinois acute- and long-term care facilities during August 2016–December 2018. During 2018, we initiated a focused effort at vSNF-A and conducted 7 C. auris PPSs; during 4 PPSs, we also performed CPO screening and environmental sampling. Results: During August 2016–December 2018 in Illinois, 490 individuals were found to be colonized or infected with C. auris. PPSs identified the highest prevalence of C. auris colonization in vSNF settings (prevalence, 23–71%). IC assessments in multiple vSNFs identified common challenges in core IC practices. Repeat PPSs at vSNF-A in 2018 identified increasing C. auris prevalence from 43% to 71%. Most residents screened during multiple PPSs remained persistently colonized with C. auris. Among 191 environmental samples collected, 39% were positive for C. auris, including samples from bedrails, windowsills, and shared patient-care items. Conclusions: High burden in vSNFs along with persistent colonization of residents and environmental contamination point to the need for prioritizing IC interventions to control the spread of C. auris and CPOs.
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C. auris can establish high-level colonization on the skin and persist for months.
“A key factor contributing to the high transmissibility of C. auris is its ability to readily establish high level colonization on the skin and persistently present for months5,10,16,17.”
From Adhesin Als4112 promotes Candida auris skin colonization through interactions with keratinocytes and extracellular matrix proteins (2025) · cites this paper as [5]
The Results (vSNF-A Chicago Facility Case Study; page not specified) document colonization across repeated surveys from January to October 2018, and the Discussion describes persistent colonization over long periods. The Methods identify axillary/groin skin swabs as the surveillance samples. The paper does not establish that skin colonization is readily acquired or consistently high-level. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCandida auris can colonize patients asymptomatically and persist on skin for months to years without causing infection.
“Candida auris, an emerging, frequently antifungal-resistant yeast, can colonize patients asymptomatically and persist on skin for months to years without causing infection (1–3).”
From Progression from <i>Candida auris</i> Colonization Screening to Clinical Case Status, United States, 2016–2023 (2025) · cites this paper as [2]
The Methods describe skin-swab surveillance for colonization, and the Results explicitly refer to asymptomatically colonized individuals. The Results and Discussion document persistent colonization during repeated surveys from January to October 2018, but do not establish persistence for years without infection. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCDC recommends colonization screening for patients with high-risk healthcare exposures and those with an epidemiologic link to a patient with C. auris.
“Because C. auris spreads easily in healthcare settings, the Centers for Disease Control and Prevention (CDC) recommends colonization screening for patients with high-risk healthcare exposures (e.g., recent stay in a long-term acute-care hospital [LTACH] or ventilator-capable skilled nursing facility [SNF]) and those with an epidemiologic link to a patient with C. auris (2,6) (https://www.cdc.gov/c”
From Progression from <i>Candida auris</i> Colonization Screening to Clinical Case Status, United States, 2016–2023 (2025) · cites this paper as [2]
The Methods (Active Surveillance and Infection-Control Assessments in Chicago; page unavailable) describe C. auris colonization screening at facilities selected because they had housed a case-patient. The Results (Illinois Surveillance; page unavailable) identify recent LTACH or vSNF residence as common among clinical cases. Our copy does not state that CDC recommends screening patients with those exposures or epidemiologic links; it describes Chicago's surveillance practice instead. (LLM, conf=0.83)
Experimental — accuracy not yet measuredC. auris spreads easily in healthcare settings.
“Because C. auris spreads easily in healthcare settings, the Centers for Disease Control and Prevention (CDC) recommends colonization screening for patients with high-risk healthcare exposures (e.g., recent stay in a long-term acute-care hospital [LTACH] or ventilator-capable skilled nursing facility [SNF]) and those with an epidemiologic link to a patient with C. auris (2,6) (https://www.cdc.gov/c”
From Progression from <i>Candida auris</i> Colonization Screening to Clinical Case Status, United States, 2016–2023 (2025) · cites this paper as [2]
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Cites
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- Authors
- Pacilli, M., Kerins, J. L., Clegg, W. J., Walblay, K. A., Adil, H., Kemble, S. K., Xydis, S., McPherson, T. D., Lin, M. Y., Hayden, M. K., Froilan, M. C., Soda, E., Tang, A. S., Valley, A., Forsberg, K., Gable, P., Moulton-Meissner, H., Sexton, D. J., Jacobs Slifka, K. M., Vallabhaneni, S., Walters, M. S., & Black, S. R.
- Affiliations
- Chicago Department of Public Health (US)
- Centers for Disease Control and Prevention (US)
- Rush University Medical Center (US)
- Illinois Department of Public Health (US)
- State of Wisconsin (US)
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, USA
- Corresponding author
- Pacilli, Massimo
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-04-14
- Volume
- 71
- Issue
- 11
- Pages
- e718-e725
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC8376188
- OpenAlex
- W3015395197
- Cited by
- 103
- References
- 1
- Citations by year
- 2026: 18 · 2025: 25 · 2024: 18 · 2023: 19 · 2022: 5 · 2021: 15 · 2020: 3
- FWCI
- 1.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement (NU50CK000367–04–02, NU50CK000367–05–00)
- Centers for Disease Control and Prevention (200–2011–42037)
- Epicenter Grant Cooperative Agreement (U54CK000481)
- 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, long-term care facilities, carbapenemase-producing organisms, fungal colonization, environmental contamination, infection control, point prevalence survey, Chicago, public health response, persistent colonization
- MeSH terms
- Candida, Chicago, Follow-Up Studies, Humans, Illinois, Ventilators, Mechanical, Skilled Nursing Facilities
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