Positive Correlation Between Candida auris Skin-Colonization Burden and Environmental Contamination at a Ventilator-Capable Skilled Nursing Facility in Chicago
Open accessAbstract
Background: Candida auris is an emerging multidrug-resistant yeast that contaminates healthcare environments causing healthcare-associated outbreaks. The mechanisms facilitating contamination are not established. Methods: C. auris was quantified in residents’ bilateral axillary/inguinal composite skin swabs and environmental samples during a point-prevalence survey at a ventilator-capable skilled-nursing facility (vSNF A) with documented high colonization prevalence. Environmental samples were collected from all doorknobs, windowsills and handrails of each bed in 12 rooms. C. auris concentrations were measured using culture and C. auris-specific quantitative polymerase chain reaction (qPCR) The relationship between C. auris concentrations in residents’ swabs and associated environmental samples were evaluated using Kendall’s tau-b (τ b) correlation coefficient. Results: C. auris was detected in 70/100 tested environmental samples and 31/57 tested resident skin swabs. The mean C. auris concentration in skin swabs was 1.22 × 105 cells/mL by culture and 1.08 × 106 cells/mL by qPCR. C. auris was detected on all handrails of beds occupied by colonized residents, as well as 10/24 doorknobs and 9/12 windowsills. A positive correlation was identified between the concentrations of C. auris in skin swabs and associated handrail samples based on culture (τ b = 0.54, P = .0004) and qPCR (τ b = 0.66, P = 3.83e−6). Two uncolonized residents resided in beds contaminated with C. auris. Conclusions: Colonized residents can have high C. auris burdens on their skin, which was positively related with contamination of their surrounding healthcare environment. These findings underscore the importance of hand hygiene, transmission-based precautions, and particularly environmental disinfection in preventing spread in healthcare facilities.
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Individuals colonized with C. auris can develop a high fungal burden on their skin, which is positively correlated with environmental contamination, transmission, and outbreaks of systemic infections.
“Individuals who have been colonized with C. auris can develop a high fungal burden on their skin, which has been positively correlated with environmental contamination, transmission, and outbreaks of systemic infections (7).”
From Yeast and filamentous <i>Candida auris</i> stimulate distinct immune responses in the skin (2024) · cites this paper as [7]
The Results section (page not provided) reports that skin colonization burden was positively associated with contamination of residents’ bed handrails. The Discussion says colonized residents can carry high skin burdens, but the study does not establish a positive correlation between skin burden and transmission or outbreaks of systemic infections. (LLM, conf=0.90)
Experimental — accuracy not yet measuredC. 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 [9]
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Cites
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Yeast and filamentous <i>Candida auris</i> stimulate distinct immune responses in the skin
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- Authors
- Sexton, D. J., Bentz, M. L., Welsh, R. M., Derado, G., Furin, W., Rose, L. J., Noble-Wang, J., Pacilli, M., McPherson, T. D., Black, S., Kemble, S. K., Herzegh, O., Ahmad, A., Forsberg, K., Jackson, B., & Litvintseva, A. P.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Clinical and Environmental Microbiology Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Chicago Department of Public Health (US)
- Enhanced Capacity Surge Laboratory, Reagent and Diagnostic Services Branch, Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
- Corresponding author
- Sexton, D Joseph
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-05-12
- Volume
- 73
- Issue
- 7
- Pages
- 1142-1148
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC8492228
- OpenAlex
- W3161661487
- Cited by
- 81
- References
- 3
- Citations by year
- 2026: 24 · 2025: 17 · 2024: 14 · 2023: 15 · 2022: 8 · 2021: 3
- FWCI
- 3.17
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Infectious Diseases (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Keywords
- Candida auris, skin colonization, environmental contamination, skilled nursing facilities, handrails, door knobs, healthcare-associated outbreaks, environmental disinfection, hand hygiene, isolation precautions, point prevalence survey, real-time PCR
- MeSH terms
- Candida, Chicago, Ventilators, Mechanical, Skilled Nursing Facilities, Infection Control
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