A cluster investigation of Candida auris among hospitalized incarcerated patients

April N. McDougal, Mary Ann Demaet, Bobbiejean Garcia, Teresa York, Thomas Iverson, Olugbenga Ojo, Janak Patel

Research output: Contribution to journalArticlepeer-review


Objective: Investigate and mitigate a cluster of Candida auris cases among incarcerated patients in a maximum-security prison hospital utilizing contact tracing, screening, whole genome sequencing, and environmental sampling and decontamination. Design: Outbreak investigation. Setting: Inpatient prison hospital affiliated with an academic tertiary referral center. Patients: Inmates of the Texas Department of Criminal Justice. Methods: Epidemiologic and environmental investigations were conducted including contact tracing, point prevalence surveys, and environmental sampling. Whole genome sequencing was performed on positive patient isolates. Results: Following a clinical case of C. auris fungemia, 344 patients underwent C. auris surveillance screening. Eight (2.3%) patients were identified with C. auris colonization. All patients were male. Our index patient was the only clinical case and death. Whole genome sequencing was performed on the nine patient isolates. All isolates were clade III (Africa) and clustered together with the largest SNP difference being 21. Environmental cultures from 7 of 61 rooms (11.5%) were positive following terminal disinfection with bleach. Sites nearest to the patient were most often positive including the hospital bed rails and bedside table. The transmission cluster was successfully mitigated within 60 days of identification. Conclusions: Implementation of an aggressive surveillance and decontamination program resulted in mitigation of a C. auris transmission cluster among our incarcerated patients. This investigation provides valuable insight into C. auris transmission in the incarcerated population, which is not considered a classic high-risk population as well as the challenges faced to stop transmission in a facility that requires the use of shared patient environments.

Original languageEnglish (US)
Article numbere244
JournalAntimicrobial Stewardship and Healthcare Epidemiology
Issue number1
StatePublished - Dec 19 2023

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases


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