title: First hospital outbreak of the globally emergingCandida aurisin a European hospital.
abstract: BACKGROUND
  Candida aurisis a globally emerging multidrug resistant fungal pathogen causing nosocomial transmission. We report an ongoing outbreak ofC. aurisin a London cardio-thoracic center between April 2015 and July 2016. This is the first report ofC. aurisin Europe and the largest outbreak so far. We describe the identification, investigation and implementation of control measures.
  
  
  METHODS
  Data onC. auriscase demographics, environmental screening, implementation of infection prevention/control measures, and antifungal susceptibility of patient isolates were prospectively recorded then analysed retrospectively. Speciation ofC. auris was performed by MALDI-TOF and typing of outbreak isolates performed by amplified fragment length polymorphism (AFLP).
  
  
  RESULTS
  This report describes an ongoing outbreak of 50C. auriscases over the first 16 month (April 2015 to July 2016) within a single Hospital Trust in London. A total of 44 % (n= 22/50) patients developed possible or provenC. aurisinfection with a candidaemia rate of 18 % (n= 9/50). Environmental sampling showed persistent presence of the yeast around bed space areas. Implementation of strict infection and prevention control measures included: isolation of cases and their contacts, wearing of personal protective clothing by health care workers, screening of patients on affected wards, skin decontamination with chlorhexidine, environmental cleaning with chorine based reagents and hydrogen peroxide vapour. Genotyping with AFLP demonstrated thatC. aurisisolates from the same geographic region clustered.
  
  
  CONCLUSIONS
  This ongoing outbreak with genotypically closely relatedC. aurishighlights the importance of appropriate species identification and rapid detection of cases in order to contain hospital acquired transmission.
authors: Department of Microbiology, Royal Brompton Hospital, London, UK ; Department of Infectious Disease Epidemiology, Imperial College School of Public Health, St Mary's Campus, London, UK.
authors: Silke
authors: 0000-0002-0108-4619
authors: S
authors: Schelenz
authors: Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands.
authors: Ferry
authors: F
authors: Hagen
authors: Department of Infectious Disease Epidemiology, Imperial College School of Public Health, St Mary's Campus, London, UK.
authors: Johanna L
authors: JL
authors: Rhodes
authors: Department of Infectious Disease Epidemiology, Imperial College School of Public Health, St Mary's Campus, London, UK.
authors: Alireza
authors: A
authors: Abdolrasouli
authors: Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
authors: Anuradha
authors: A
authors: Chowdhary
authors: Department of Microbiology, Royal Brompton Hospital, London, UK.
authors: Anne
authors: A
authors: Hall
authors: Department of Microbiology, Royal Brompton Hospital, London, UK.
authors: Lisa
authors: L
authors: Ryan
authors: Department of Microbiology, Royal Brompton Hospital, London, UK.
authors: Joanne
authors: J
authors: Shackleton
authors: Department of Surgery, Royal Brompton Hospital, London, UK.
authors: Richard
authors: R
authors: Trimlett
authors: Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands ; Radboudumc/CWZ Centre of Expertise in Mycology, Nijmegen, The Netherlands.
authors: Jacques F
authors: JF
authors: Meis
authors: Department of Microbiology, Royal Brompton Hospital, London, UK ; Department of Infectious Disease Epidemiology, Imperial College School of Public Health, St Mary's Campus, London, UK.
authors: Darius
authors: D
authors: Armstrong-James
authors: Department of Infectious Disease Epidemiology, Imperial College School of Public Health, St Mary's Campus, London, UK.
authors: Matthew C
authors: MC
authors: Fisher
keywords: AFLP Genotyping; Candida auris; Healthcare-associated infections; Outbreak