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is an emerging multidrug-resistant fungal pathogen associated with bloodstream, wound and other infections, especially in critically ill patients. carriage is persistent and is difficult to eradicate from the hospital environment.


We aimed to pilot admission screening for in intensive care units (ICUs) in England to estimate prevalence in the ICU population and to inform public health guidance.


Between May 2017 and April 2018, we screened admissions to eight adult ICUs in hospitals with no previous cases of in three major cities. Swabs were taken from the nose, throat, axilla, groin, perineum, rectum and catheter urine, then cultured and identified using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). Patient records were linked to routine ICU data to describe and compare the demographic and health indicators of the screened cohort with a national cohort of ICU patients admitted between 2016 and 2017.


All screens for 921 adults from 998 admissions were negative. The upper confidence limit of the pooled prevalence across all sites was 0.4%. Comparison of the screened cohort with the national cohort showed it was broadly similar to the national cohort with respect to demographics and co-morbidities.


These findings imply that colonisation among patients admitted to ICUs in England is currently rare. We would not currently recommend widespread screening for in ICUs in England. Hospitals should continue to screen high-risk individuals based on local risk assessment.


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  1. Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol. 2009;53(1):41-4.  https://doi.org/10.1111/j.1348-0421.2008.00083.x  PMID: 19161556 
  2. Jeffery-Smith A, Taori SK, Schelenz S, Jeffery K, Johnson EM, Borman A, et al. Candida auris: a Review of the Literature. Clin Microbiol Rev. 2017;31(1):e00029-17.  https://doi.org/10.1128/CMR.00029-17  PMID: 29142078 
  3. Chowdhary A, Sharma C, Meis JF. Candida auris: A rapidly emerging cause of hospital-acquired multidrug-resistant fungal infections globally. PLoS Pathog. 2017;13(5):e1006290.  https://doi.org/10.1371/journal.ppat.1006290  PMID: 28542486 
  4. Lockhart SR, Etienne KA, Vallabhaneni S, Farooqi J, Chowdhary A, Govender NP, et al. Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses. Clin Infect Dis. 2017;64(2):134-40.  https://doi.org/10.1093/cid/ciw691  PMID: 27988485 
  5. Schelenz S, Hagen F, Rhodes JL, Abdolrasouli A, Chowdhary A, Hall A, et al. First hospital outbreak of the globally emerging Candida auris in a European hospital. Antimicrob Resist Infect Control. 2016;5(1):35.  https://doi.org/10.1186/s13756-016-0132-5  PMID: 27777756 
  6. Public Health England (PHE). Guidance for the laboratory investigation, management and infection prevention and control for cases of Candida auris v2.0. London: PHE; Aug 2017. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/637685/Updated_Candida_auris_Guidance_v2.pdf
  7. European Centre for Disease Prevention and Control (ECDC). Rapid risk assessment: Candida auris in healthcare settings - Europe. Stockholm: ECDC; 23 Apr 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/rapid-risk-assessment-candida-auris-healthcare-settings-europe
  8. Plachouras D, Lötsch F, Kohlenberg A, Monnet DL, Candida auris survey collaborative group. Candida auris: epidemiological situation, laboratory capacity and preparedness in the European Union and European Economic Area*, January 2018 to May 2019. Euro Surveill. 2020;25(12).  https://doi.org/10.2807/1560-7917.ES.2020.25.12.2000240  PMID: 32234118 
  9. Eyre DW, Sheppard AE, Madder H, Moir I, Moroney R, Quan TP, et al. A Candida auris Outbreak and Its Control in an Intensive Care Setting. N Engl J Med. 2018;379(14):1322-31.  https://doi.org/10.1056/NEJMoa1714373  PMID: 30281988 
  10. Borman AM, Szekely A, Johnson EM. Isolates of the emerging pathogen Candida auris present in the UK have several geographic origins. Med Mycol. 2017;55(5):563-7.  https://doi.org/10.1093/mmy/myw147  PMID: 28204557 
  11. Brown CS, Guy R. National Public Health Response to Candida auris in England. J Fungi (Basel). 2019;5(4):E93.  https://doi.org/10.3390/jof5040093  PMID: 31623348 
  12. Public Health England (PHE). English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report. London: PHE; 10 Oct 2017. Available from: https://webarchive.nationalarchives.gov.uk/20191003132022/https://www.gov.uk/government/publications/english-surveillance-programme-antimicrobial-utilisation-and-resistance-espaur-report
  13. Department of Health expert advisory committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI). Implementation of modified admission MRSA screening guidance for NHS (2014). London: Department of Health; 2014. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/345144/Implementation_of_modified_admission_MRSA_screening_guidance_for_NHS.pdf
  14. Decraene V, Phan HTT, George R, Wyllie DH, Akinremi O, Aiken Z, et al. A Large, Refractory Nosocomial Outbreak of Klebsiella pneumoniae Carbapenemase-Producing Escherichia coli Demonstrates Carbapenemase Gene Outbreaks Involving Sink Sites Require Novel Approaches to Infection Control. Antimicrob Agents Chemother. 2018;62(12):e01689-18.  https://doi.org/10.1128/AAC.01689-18  PMID: 30249685 
  15. Vogelzang EH, Weersink AJL, van Mansfeld R, Chow NA, Meis JF, van Dijk K. The First Two Cases of Candida auris in The Netherlands. J Fungi (Basel). 2019;5(4):E91.  https://doi.org/10.3390/jof5040091  PMID: 31574934 
  16. Office for National Statistics (ONS). Travel trends: 2018. London: ONS; 2019. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/leisureandtourism/articles/traveltrends/2018
  17. Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill. 2018;23(46).  https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800516  PMID: 30458912 
  18. Public Health England (PHE). Laboratory surveillance of candidaemia in England, Wales and Northern Ireland: 2017. Health Protection Report. 2018;12(34). Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/742602/hpr3418_cnddm17.pdf
  19. Intensive care national audit and research centre (ICNARC). Case Mix Programme Summary Statistics 2016-17. London: INARC; 2018. Available from: https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports/Summary-Statistics
  20. Bentz ML, Sexton DJ, Welsh RM, Litvintseva AP. Phenotypic switching in newly emerged multidrug-resistant pathogen Candida auris. Med Mycol. 2018. PMID: 30329075 
  21. Fraser M, Brown Z, Houldsworth M, Borman AM, Johnson EM. Rapid identification of 6328 isolates of pathogenic yeasts using MALDI-ToF MS and a simplified, rapid extraction procedure that is compatible with the Bruker Biotyper platform and database. Med Mycol. 2016;54(1):80-8. PMID: 26591008 
  22. Sharp A, Borman AM, Perera N, Randle M, Braham S, Taori S, et al. Assessing routine diagnostic methods for detecting Candida auris in England. J Infect. 2018;77(5):448-54.  https://doi.org/10.1016/j.jinf.2018.07.012  PMID: 30063914 
  23. Caggiano G, Puntillo F, Coretti C, Giglio M, Alicino I, Manca F, et al. Candida colonization index in patients admitted to an ICU. Int J Mol Sci. 2011;12(10):7038-47.  https://doi.org/10.3390/ijms12107038  PMID: 22072934 
  24. Welsh RM, Bentz ML, Shams A, Houston H, Lyons A, Rose LJ, et al. Survival, Persistence, and Isolation of the Emerging Multidrug-Resistant Pathogenic Yeast Candida auris on a Plastic Health Care Surface. J Clin Microbiol. 2017;55(10):2996-3005.  https://doi.org/10.1128/JCM.00921-17  PMID: 28747370 
  25. Leach L, Zhu Y, Chaturvedi S. Development and Validation of a Real-Time PCR Assay for Rapid Detection of Candida auris from Surveillance Samples. J Clin Microbiol. 2018;56(2):e01223-17.  PMID: 29187562 
  26. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323-9.  https://doi.org/10.1001/jama.2009.1754  PMID: 19952319 
  27. Stéphan F, Bah MS, Desterke C, Rézaiguia-Delclaux S, Foulet F, Duvaldestin P, et al. Molecular diversity and routes of colonization of Candida albicans in a surgical intensive care unit, as studied using microsatellite markers. Clin Infect Dis. 2002;35(12):1477-83.  https://doi.org/10.1086/344648  PMID: 12471566 
  28. Tsay S, Kallen A, Jackson BR, Chiller TM, Vallabhaneni S. Approach to the Investigation and Management of Patients With Candida auris, an Emerging Multidrug-Resistant Yeast. Clin Infect Dis. 2018;66(2):306-11.  https://doi.org/10.1093/cid/cix744  PMID: 29020224 

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