Lab Matters Summer 2019 - Page 11

FEATURE Having the laboratory capacity to process these colonization swabs is a huge thing. The whole aim here is timely data to allow us to take the appropriate infection control and public health actions.” Marion Kainer, MD, MPH The Candida team from the Wadsworth Center Mycology Laboratory. First row (from l to r): Yan Chun Zhu, Brittany O’Brien, Sudha Chaturvedi. Second row (from l to r): Mitchell Kaplan, Manuel Pazos, Jiali Liang, Rokebul Anower. Photo: Wadsworth Center One organism so far undetected in Tennessee, but an emerging problem elsewhere in the US is antibiotic-resistant Candida auris. “When CDC put out the original [AR] threats report in 2013, we didn’t even mention this, because we didn’t know about it,” said Craig. “It seems to have emerged independently in multiple places around the world and then spread. We don’t know yet how or why it emerged when it did.” Antibiotic-resistant Candida auris is known for its extreme hardiness in the environment; its ability to colonize the human gut, skin and bloodstream—and a mortality rate as high as 80%, depending on the strain and infection site. The organism was first described in a Japanese patient in 2009 and first identified in New York state at the time of a multi-hospital outbreak in New York City (NYC) in 2016. According to the New York State Department of Health, it can now “probably be considered endemic within some parts of the healthcare system in Brooklyn and Queens.” As of May 31, 2019, the Wadsworth Center—the New York state public health laboratory and Northeast Regional AR Lab Network Laboratory—confirmed 334 clinical cases of drug-resistant C. auris among NYC residents, with infection PublicHealthLabs @APHL almost exclusively limited to people with extensive healthcare needs, such as nursing home residents with chronic ventilator usage and people with multiple ICU admissions. To speed detection of the organism during the outbreak, Wadsworth scientists moved from MALDI-TOF mass spectrometry testing—which requires culturing specimens over 4 to 14 days—to a rapid molecular assay developed in-house. The new assay provides results within one day of specimen receipt. To date, the Wadsworth Center has screened over 17,000 surveillance specimens from the NYC area and detected drug-resistant C. auris on the skin of over 450 healthy individuals, 40 of whom went on to develop illness and are also included in the clinical case count. The Center’s molecular assay has been adopted by CDC and several other AR Lab Network members. “If we’re not looking for it, it’s going to disseminate” nurses and other stakeholders across the healthcare system; and working with sentinel laboratories that serve high-risk populations, such as ventilated nursing home patients and “medical tourists” who have had healthcare abroad. “When you’re doing [AR] surveillance, you want to be sure you’re looking at the places where you expect to find it,” she said. Historically, said Craig, “Even in the US we haven’t done as good a job as we should have to detect and respond to [AR pathogens].” He said, “With the AR Lab Network, now we have an infrastructure to do that, and I’m thankful and grateful for all the hard work laboratorians have put in to support the network; they are fundamental to its success.” Without laboratory data, Craig said, “there’s really not a good understanding about what [drug-resistant] strains are developing, how they’re emerging and what’s likely to be transmitted locally and globally.” He warned, “If we’re not looking for it, it’s going to disseminate secretly and quietly around the world.” n Containing the threat posed by drug- resistant pathogens is an ongoing project. Kainer said jurisdictions can assist by making drug-resistant conditions reportable and requiring isolate submission; conducting tabletop exercises with laboratorians, hospital and nursing home risk managers, infection control APHL.org Summer 2019 LAB MATTERS 9