Authors (including presenting author) :
Fong CH(1),Yeung MP(1),Yu KK(1),Lung DC(2),Yau A(3),Mo MM(1)
Affiliation :
(1)Department of Rehabilitation, Kowloon Hospital (2)Department of Pathology, Queen Elizabeth Hospital/Hong Kong Children’s Hospital (3)Respiratory Medicine Department, Kowloon Hospital
Introduction :
Starting from 3rd September 2023, 3B ward at Rehabilitation Building, Kowloon Hospital(KH) became the designated ward to provide Candida auris(C.auris) cases management in Kowloon Central Cluster(KCC).The aim of 3B cohort ward to contain all C.auris cases in KCC was not only to facilitate the implementation of strict contact precaution, our setting also targeted air dispersal.
Objectives :
Review the service of C.auris cases at Kowloon Hospital
Methodology :
A retrospective review was performed on patients transferring to 3B ward in the period from 3rd September 2023 to 3rd December 2023
Result & Outcome :
A total of 98 patients colonized with C.auris was transferred to 3B ward.30.6%were female and 69.4%were male with a mean age75. The principle diagnosis was mainly pneumonia(39.7%),urinary tract infection and sepsis(20.4%),traumatic brain injury and cerebrovascular disease(19.3%).All patients only had C.auris colonization and none developed infection all along. Concerning the risk factors for C.auris colonization,95.9%of patients had received broad spectrum antibiotics. Other risk factors included diabetes mellitus(34.7%),chronic renal disease(15.3%),permanent urinary catheterization(12.2%),blood transfusion(6.1%),admission to intensive care unit(5.1%),previous antifungal agents within 30 days(4%),parental nutrition(3%) and presence of central venous catheter(3%). QEH-KH-BH Decolonization protocol was followed and two male patients were successfully decolonized.Both had diagnosis of traumatic brain injury and only one risk factor for C.auris (diabetes mellitus)was identified.Their baseline Functional Independence Measure(FIM) score was 42 and 46 with average gain 31.5 in FIM score. 62.3%of patients was successfully discharged to either home(27.6%) with average length-of-stay(LOS) 31.3 days or home for the aged(34.7%) with LOS 40.8 days.16.4%was referred to Integrated-Rehabilitation-Day-Centre at KH(9.8%) or Geriatric-Day-Hospital(6.6%).The readmission rate within 28 days for discharged positive C.auris cases was 23.7%. Around 10% of these patients passed away in KH and none of them suffered from C.auris infection as their cause of death. 60%among them were under End-Of-Life care program.13.3%was still staying at KH because of financial reason for arranging placement as single room contact precautions was required. In conclusion, the emergence of C. auris through KCC has resulted in a great disruption in clinical service and patient placement.KH 3B ward act as an important hub for cluster control of C. auris,cohorting all stable cases for 7 hospitals in KCC.Receiving broad-spectrum antibiotics is one of the major risk factors and so, judicious use of broad-spectrum antibiotics should be practiced.Despite contact precautions are important,rehabilitation of these patients should not be compromised.
