1445. Public Health Containment Response Detects Possible Transmission of Echinocandin-Resistant Candida auris in a Long-term Acute Care Hospital

Abstract Background Candida auris is an emerging fungal pathogen which is often multidrug-resistant, can cause severe infections, and spreads readily in healthcare settings. While echinocandin resistance (ech-R) remains low in the United States (< 5%), the number has been increasing, which is concerning because echinocandins are first-line therapy for C. auris infections. In May 2022, the first ech-R C. auris isolate in Michigan was detected at long-term acute care hospital (LTACH) A and enhanced lab surveillance was conducted to assess potential for ech-R transmission. Methods Upon detection of C. auris in a urine specimen at LTACH A in March 2022, a containment response was initiated, which included clinical surveillance and colonization screening of patients at LTACH A. C. auris colonization screening testing and antifungal susceptibility testing (AFST) was performed at Wisconsin State Laboratory of Hygiene and whole genome sequencing (WGS) by the CDC. Ech-R was determined using tentative breakpoints defined by CDC. Results From Mar 2022 – Sept 2022, 15 C. auris-positive specimens were detected from 12 patients at LTACH A (5 clinical specimens, 10 screening swabs). In May 2022, AFST on a blood isolate from a C. auris-colonized patient showed resistance to azole and echinocandin classes. This patient had no history of prior echinocandins use. AFST conducted on 12 available isolates (5 clinical, 7 screening) detected ech-R in 10 (83%) isolates (3 clinical, 7 screening); all isolates were resistant to azoles and susceptible to polyenes. WGS was performed on 4 isolates and revealed 3 closely-related clade III isolates (all ech-R), suggesting possible facility transmission, and 1 clade IV isolate (susceptible), suggesting a separate introduction. Conclusion Multiple ech-R C. auris isolates detected among patients overlapping in the same facility and with close genetic relatedness provide further evidence that echinocandin resistant strains can be transmitted among patients and raise concerns about spread to a larger population of patients without prior echinocandin use. Enhanced surveillance for C. auris detection and antifungal resistance, public health reporting, and robust infection prevention and control measures are critical to containing the spread of concerning resistance. Disclosures All Authors: No reported disclosures