Candida auris Containment Responses in Health Care Facilities that Provide Hemodialysis Services - New Jersey, North Carolina, South Carolina, and Tennessee, 2020-2023.

Candida auris, a frequently multidrug-resistant fungal pathogen, poses an urgent public health threat due to its potential to spread within and between health care facilities. Facilities that offer dialysis services might face particular challenges in preventing and containing C. auris and other multidrug-resistant pathogens, given the frequent use of invasive treatments in an immune-compromised patient population. During 2020-2023, in five separate facilities providing dialysis care across four states (New Jersey, North Carolina, South Carolina, and Tennessee), six patients infected or colonized with C. auris received dialysis treatment for up to 4 months; five patients' C. auris status was unknown to the facilities treating them. A review of public health response efforts carried out in these facilities was conducted. Before the facilities became aware of these patients' C. auris status, they implemented recommended standard but not C. auris-specific infection prevention and control (IPC) measures for the dialysis setting. Colonization testing of 174 potentially exposed patient contacts identified one additional patient whose previously detected C. auris colonization was not known to the dialysis facility, but no additional positive test results. Lapses in communication among health care facilities (e.g., acute care, long-term care, and dialysis) and public health jurisdictions posed a significant impediment to containment response efforts by most participating states. Adherence to standard dialysis IPC practices appeared to enable safe provision of dialysis to patients with C. auris colonization or infection without transmission to other dialysis patients. However, improved interfacility communication regarding patients' infection or colonization status with multidrug-resistant organisms is needed to ensure prompt implementation of all recommended IPC practices. More evidence is needed to understand the prevalence of and risk factors associated with C. auris transmission in the dialysis setting.