C auris Discovery Through Community Wastewater Surveillance

Abstract and Introduction

Abstract

Candida auris transmission is steadily increasing across the United States. We report culture-based detection of C. auris in wastewater and the epidemiologic link between isolated strains and southern Nevada, USA, hospitals within the sampled sewershed. Our results illustrate the potential of wastewater surveillance for containing C. auris.

Introduction

The COVID-19 pandemic has showcased wastewater surveillance as an effective and economical tool for monitoring disease transmission levels and guiding public health interventions.^[1–2] Wastewater surveillance could also conceivably contribute to early detection of drug-resistant organisms of high relevance, such as carbapenem-resistant Enterobacterales and the yeast Candida auris.^[3] Carbapenem-resistant Enterobacterales have been recovered from influent of wastewater treatment plants (WWTPs), as well as from effluent from healthcare facilities.^[4–5] Various fungi and yeast species have also been cultured from wastewater.^[6]

C. auris was first described at the species level in 2009 and quickly became a notable nosocomial pathogen, displaying high levels of resistance to azoles and, to a lesser extent, polyenes and echinocandins.^[7] Limited treatment options, substantial pathogenicity, and environmental persistence in healthcare settings define C. auris as one of the most formidable public health threats in the world.^[7] Epidemiologically, C. auris isolates are assigned to 5 distinct genomic clades describing their original endemicity patterns: I (southern Asia), II (eastern Asia), III (Africa), IV (South America), and V (Iran).^[7,8] We illustrate the potential utility of community-level wastewater surveillance for C. auris through culture-based monitoring at 2 WWTPs in southern Nevada, USA, while they were receiving sewage from healthcare facilities experiencing an outbreak.