1242 infection control & hospital epidemiology october 2017, vol. 38, no. 10


resulted in significantly greater measured log reductions (mean±SE) for Virex II 256 against C. albicans (3.3±0.4 versus 0.5±0.4), C. glabrata (3.8±0.4 vs 0.4±0.2), and C. auris (2.2±.2 vs 0.7±0.3) (P<.05 for each comparison), but not MRSA (ie, ~6 log10CFU reductions with both methods), when the inoculum was 106 CFUs per carrier (P<.05 for each comparison). For the ASTM E2197-11 method, reducing the inoculum


differences in reductions for different strains. The 3 bleach disinfectants, OxyCide, Clorox Healthcare hydrogen peroxide cleaner disinfectant, and Oxivir TB consistently reduced the Candida species by ≥5 log10 CFU, and there were no significant differences in reductions for the Candida species and MRSA (P>.05). Vinegar, Purell Healthcare surface disinfectant (Gojo, Akron, OH), and the 2 quaternary ammonium disinfectants were significantly less effective against Candida species than against MRSA (P≤.02). There were no significant differences in efficacy against C. auris versus the other Candida species. Compared to the ASTM method, the AOAC method


than C. auris. In a recent study,we demonstrated that C. auris and other Candida species have a similar propensity to survive on surfaces, and Candida species were frequently recovered from the hospital environment, particularly from moist surfaces.10 Moreover, previous studies have implicated the environment as a potential source for transmission of Candida species.11 Our study has some limitations.Westudied only 2 quaternary


ammoniumdisinfectants and cannot exclude the possibility that other quaternary ammonium compounds may have greater activity. We did not assess the efficacy of the disinfectants on hospital surfaces. It is possible that quaternary ammonium compoundsmay exhibit greater efficacy on real-world surfaces if smaller numbers of Candida species are present.


acknowledgments


Financial support: This work was funded by a Merit Review grant (grant no. BX002944-01A1) from the Department of Veterans Affairs to C.J.D. Potential conflicts of interest: C.J.D. has received research grants from Merck,


such that 104 CFUs were recovered from the control carriers significantly enhanced the measured reduction in Candida species achieved by Virex II 256 (~3 vs 0.5 to 2 log reduction; P<.01). For the AOAC method, a similar reduction in the inoculum resulted in 4 log reductions in each of the Candida species (data not shown).


discussion


Many disinfectants have an EPA-registered fungal claim based on efficacy against C. albicans or Trichophyton menta- grophytes.5 However, interim recommendations from theCDC have specified that an EPA-registered hospital-grade disin- fectant effective against C. difficile spores be used for C. auris.4 Our results provide support for that recommendation but also demonstrate that nonsporicidal improved hydrogen peroxide disinfectants are highly active against Candida species, including C. auris. There was no evidence that C. auris has greater resistance to disinfectants than do other Candida species. The relatively poor activity of the quaternary ammonium


disinfectants against all Candida species is concerning because these agents are widely used. In contrast to MRSA, we found that differences in test methods may markedly impact the measured efficacy of quaternary ammonium disinfectants against Candida species. Our results suggest that factors such as use of a smaller organism inoculum and spreading of the inoculum may enhance the measured reductions. In that regard, it should be noted that the EPA has recently released interim guidance for testing the efficacy of liquid anti- microbials against C. auris6; the recommended methods are similar to the ASTM method used in our study, and both methods yield similar results (unpublished data). It is possible that the environment may be an under- appreciated reservoir for the spread of Candida species other


GOJO, Altapure, EcoLab, and Clorox and serves on advisory boards for 3M and Synthetic Biologics. All other authors report no conflicts of interest relevant to this article.


Affiliations: 1. Research Service, Louis Stokes Veterans Affairs Medical


Center, Cleveland, Ohio; 2. Case Western Reserve University School of Medicine, Cleveland, Ohio; 3. Center for Medical Mycology, Case Western Reserve University, Cleveland, Ohio; 4. University Hospitals Cleveland Medi- cal Center, Cleveland, Ohio; 5. Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio Address correspondence to Curtis J. Donskey, MD, Geriatric Research, Education, and Clinical Center 1110W, Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106 (Curtis.Donskey@va.gov).


Received May 8, 2017; accepted July 5, 2017; electronically published August


10, 2017 © 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3810-0015. DOI: 10.1017/ice.2017.162


references


1. Vallabhaneni S, Kallen A, Tsay S, et al. Investigation of the first seven reported cases of Candida auris, a globally emerging inva- sive, multidrug-resistant fungus—United States, May 2013– August 2016. Am J Transplant 2017;17:296–299.


2. Schelenz S, Hagen F, Rhodes JL, et al. First hospital outbreak of the globally emerging Candida auris in a European hospital. Antimicrob Resist Infect Control 2016;5:35.


3. Larkin E, Hager C, Chandra J, et al. The emerging Candida auris: characterization of growth phenotype, virulence factors, anti- fungal activity, and effect of SCY-078, a novel glucan synthesis inhibitor, on growth morphology and biofilm formation. Antimicrob Agents Chemother 2017;Feb 21. pii: AAC 02396–16.


4. Fungal diseases: Candida auris. Centers for Disease Control and Preventions website. https://www.cdc.gov/fungal/diseases/ candidiasis/candida-auris.html. Updated 2017. Accessed July 10, 2017.


5. List K: EPA’s registered antimicrobial products effective against Clostridium difficile spores. US Environmental Protection Agency website. https://www.epa.gov/sites/production/files/2017- 01/documents/20172701.listk_.pdf. Published 2017. Accessed July 10, 2017.


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