Original Candida auris : Diagnostic challenges and outbreak control in paediatric and neonatal intensive care unit in a tertiary care hospital- the first of many in Eastern India

Problem considered: An emerging global threat, Candida auris infections have poor prognosis, high transmission rate, and potential for outbreaks. In India, prevalence of Candida auris invasive infection has been calculated to be 5.3 %. Strict surveillance and preventive measures must be implemented in intensive care units because of its propensity for rapid adaptation and potential for antifungal resistance. Methods: Outbreak investigational study was carried in paediatric and neonatal intensive care unit of a tertiary care hospital in eastern India. Clinical isolates from inpatients with candidemia were subjected to identification by microbiological tests. Deoxyribonucleic acid (DNA) sequencing done for molecular identification and determining clonal similarity of Candida auris isolates. Surveillance of intensive care units carried out to assess patient colonization, environmental contamination, and hand-carriage of yeast among healthcare workers following which strict infection control measures were implemented. Results: Blood isolates from four candidemia patients identified microbiologically as Candida auris . Environmental surfaces found contaminated with Candida auris by surveillance included Ultrasound guided (USG) Accuprobe and Blood-pressure (BP) cuff used for all patients admitted, molecular identification of which showed homology with patient isolates. However, patients and hospital environment no longer harboured Candida auris owing to stringent Infection Prevention and Control (IPC) measures taken. Conclusion: The article emphasises multidisciplinary approach towards investigation and containment of Candida auris outbreak and how prompt surveillance and simple preventive measures could eradicate Candida auris from patients and hospital setting.