Research and analysis

Candida auris within the United Kingdom: updated guidance published

Updated 11 August 2017

PHE has published new guidance on the management of Candida auris, including an updated version of guidance on laboratory investigation, management and infection control, originally published in June 2016 [1]; this has been updated to reflect the increasing experience of the complexities of managing C. auris cases (within several UK NHS Trusts, Health Protection Teams, and the national incident management team), and recognition of some additional novel aspects of outbreak control.

The updated guidance for laboratories and healthcare providers is published alongside new guidance intended primarily for healthcare professionals in nursing homes, that can be adapted for residential homes and other community care settings [2]. This is aimed at facilitating the discharge or transfer of patients of hospital patients into community settings.

A new patient information leaflet is also available for healthcare professionals in hospitals and community care facilities to download and either circulate directly to colonised individuals and their families, or adapt for other purposes [3].

As at the beginning of July 2017, 20 separate NHS Trusts and independent hospitals in the United Kingdom had detected over 200 patients colonised or infected with C. auris. Three hospitals have seen large nosocomial outbreaks that have proved difficult to control, despite intensive infection prevention and control measures. As of Monday 14 August, all 3 hospitals had declared their outbreaks over. Over 35 other hospitals have had patients known to be colonised with C. auris transferred to them.

Most detections within the UK have been from colonised patients, picked up through enhanced surveillance activities in the 3 most affected hospitals. Approximately one quarter of detections have been clinical infections, including 27 patients who developed blood stream infections.

Look-back exercises from the Trusts with significant outbreaks have shown that for patients with clinical infections there has been no attributable mortality to C. auris within the UK, in contrast to the high case fatality reported in the literature. It is important to note that these case series are not accompanied by comparable background mortality rates in the critical care centres they have been reported from.

A pilot survey of patients being admitted to ICU was launched in July 2017, with screening of all patients on ward entry to critical care settings in 5 English hospitals serving diverse populations to determine the background rate of colonisation. The results of this will help inform future surveillance strategies.

PHE’s National Infection Service continues to work closely with microbiologists and clinicians in hospitals to investigate potential risk factors for colonisation and clinical infection, and the Biosafety Investigation Unit at PHE Porton Down is investigating the fungicidal activity of a variety of disinfectants and antiseptics.

0.1 References

1. PHE (August 2017). Guidance for the laboratory investigation, management and infection prevention and control for cases of Candida auris
2. PHE (August 2017). Candida auris: infection control in community care settings.
3. PHE (August 2017). Candida auris: a guide for patients and visitors.

This is an HPR Advance Access report published on 11 August 2017.