Infection Control & Hospital Epidemiology (2019), 40,380–382 doi:10.1017/ice.2019.1
Research Brief
Susceptibility of Candida auris and Candida albicans to 21 germicides used in healthcare facilities
William A. Rutala PhD, MPH1, Hajime Kanamori MD, PhD, MPH1,2,3, Maria F. Gergen MT (ASCP)2, Emily E. Sickbert-Bennett PhD1,2 and David J. Weber MD, MPH1,2 1Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States, 2Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina, United States and 3Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
(Received 26 July 2018; accepted 6 October 2018)
Candida auris is an emerging fungal pathogen that is often resist- ant to major classes of antifungal drugs. It is considered a serious global health threat because it can cause severe infections with fre- quent mortality in more than a dozen countries. It can survive on healthcare environmental surfaces for at least 7 days and can cause outbreaks in healthcare facilities. Clearly, infection prevention strategies, such as surface disinfection, will be essential to control- ling Candida transmission. Unfortunately, data on the activity of antiseptics and disinfectants used in healthcare to inactivate this pathogen are limited.1–5 In this study, we investigated 12 different disinfectants (ie, 8 low- and intermediate-level disinfectants in 2 dilutions of sodium hypochlorite and 5 high-level disinfectants/ chemical sterilants) and 9 antiseptics commonly used in healthcare facilities for their antimicrobial activity against C. auris and C. albicans. We used the disc-based quantitative carrier testing to evaluate
the germicidal activity of multiple antiseptics and disinfectants against the emerging pathogen C. auris.6,7 We considered the car- rier test to mimic disinfectant application on an inanimate surface in a clinical environment better than a suspension test commonly reported by manufacturers and the published literature. The C. auris isolate used was Antibiotic Resistance Bank no. 0385 from the Centers for Disease Control and Prevention. Based on tentative minimum inhibitory concentration (MIC) breakpoints,8
this iso-
late was resistant to fluconazole and was susceptible to anidulafun- gin, micafungin, caspofungin, and amphotericin B. To determine whether C. auris susceptibility to germicides was similar to that of other Candida species, we also tested C. albicans (ATCC strain no. 60193). In brief, 10 μL inoculum containing∼104 with 5% fetal calf serum of C. auris or C. albicans was placed onto each stainless steel disc (1 cm diameter) and dried in a vacuum desiccator for 2 hours. After drying, each carrier was placed in a plastic vial with the ino- culated side up. The dried inoculum was entirely covered by 50 μL of the test germicide for 1 minute at room temperature (∼20°C), Then 9.95 mL eluent with neutralizer (Dey/Engley neutralizing
Author for correspondence: William A. Rutala, Email:
brutala@med.unc.edu PREVIOUS PRESENTATION. This work was presented in part as a poster (no. 483) at
IDWeek 2017 on October 5, 2017, in San Diego, California. Cite this article: Rutala WA, et al. (2019). Susceptibility of Candida auris and Candida
albicans to 21 germicides used in healthcare facilities. Infection Control & Hospital Epidemiology, 40: 380–382,
https://doi.org/10.1017/ice.2019.1
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.
broth) was added into each carrier holder to dilute and neutralize the germicide. Serial dilutions of the eluates were filtered to evalu- ate the fungal viability and to achieve countable numbers. The membrane filters of appropriate serial dilutions were placed on sheep blood agar plates and incubated for 24–48 hours at 37°C, and the fungal were then counted. We performed 3 replicates for each organism and germicide. Also, 3 carrier controls were pre- pared during each experiment in the manner described above but without germicide exposure. Compared to mean carrier control counts, the log10 reduction of the test organism for each germicide was calculated.9 The efficacy of germicides with active ingredient, product
name, manufacturer, and classification against C. auris and C. albicans are provided in Table 1. Under the challenging test con- ditions (ie, 5% FCS and 1 minute exposure time), 12 of 22 tested disinfectants and antiseptics (55%) demonstrated at least a 3-log10 reduction, and 16 (73%) demonstrated at least a 2-log10 reduction for C. auris. Also, 14 of these 22 (64%) demonstrated at least a 3-log10 reduction, and 17 (77%) demonstrated at least a 2-log10 reduction for C. albicans. Of the 9 antiseptics, 7 (78%) did not demonstrate a 3-log10 reduction against C. auris; these included 10% povidone-iodine, 0.5% triclosan, 1% chloroxylenol, 1% chlorhexidine gluconate (CHG) with 61% ethyl alcohol, 2% CHG, 4% CHG, and 3% hydrogen peroxide. Of 13 tested disinfec- tants (low-level disinfectants and high-level disinfectants), 10 (77%) demonstrated at least a 3-log10 reduction at 1 minute, with 3 exceptions: (1) a 1:50 dilution of 5.25% sodium hypochlorite (∼1,245 ppm chlorine; Chlorine Test Kit, Model CN-21P, Hach, Loveland, CO); (2) a diluted, water-based quaternary ammonium compound (QAC); and (3) a 0.55% ortho-phthalaldehyde. In gen- eral, the log10 reductions for C. auris and C. albicans were similar: 12 of 13 (92%) within a 1 log10 difference) for the 13 tested disinfectants. But 4 of 9 (44%) of the antiseptics had a >1 log10 difference in susceptibility. There is no standard level of germicidal efficacy for environmen-
tal surfaces, butmost of the disinfectants tested that demonstrated at least a 3-log10 reduction are likely to be clinically effective against C. auris when used appropriately. Some of the Environmental Protection Agency (EPA)–registered disinfectants used in this study have an EPA registration claim longer than the 1 minute used in this study. All of the FDA-cleared high-level disinfectants have a
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