Oxford ICU Candida outbreak linked to multi-use thermometers

Between 2 February 2015 and 31 August 2017, 70 patients were colonised or infected with Candida auris in the neurosciences intensive care unit (NICU) of the Oxford University Hospitals. Now details presented at the 28th European Congress of Clinical Microbiology and Infectious Diseases in Spain last weekend suggests the outbreak could have been caused by multi-use thermometers. 94% of the patients involved were admitted to the NICU prior to diagnosis. Only 7 patients developed invasive C auris infections, of whom one died, 229 days after their last invasive isolate. Analysis of the data found that independent predictors of C auris colonisation/infection included multi-patient use skin surface axillary temperature monitoring (OR, 6.80; 95% CI, 2.96-15.64; P<.001) and systemic fluconazole (OR, 10.2; 95% CI, 1.64-63.5; P=.01). C auris was cultured from multi-patient use equipment, including multiple axillary skin-surface temperature probes, and visualised on probe surfaces using scanning electron microscopy. The isolates proved to be resistant to fluconazole (100%), voriconazole (98%), posaconazole (90%) and amphotericin (18%). The median duration of colonisation was 39 days. Adjusting for age, sex and primary admission diagnosis, there was no evidence that C aurisacquisition was associated with increased mortality (HR, 1.21; 95% CI, 0.64-2.29; P=.55). During the outbreak, multiple infection control interventions were put in place, but the outbreak was only controlled after removal of the temperature probes.