Hospital Admission Screening for CPO and C. auris Colonization

Receipt of health care abroad, and in certain U.S. regions where carbapenemase-producing organisms (CPOs) and Candida auris are more common, are risk factors for patients to be colonized with these organisms. Both CPOs and C. auris can cause asymptomatic colonization in patients that can lead to transmission in health care facilities if the appropriate infection control measures are not taken. Therefore, it is important to initiate hospital admission screening to rapidly identify and immediately implement infection control measures for residents or patients colonized with CPOs or C. auris, which is key to controlling the spread.

On this page:
MDH Admission Screening Recommendations
Laboratory Testing
Specimen Collection and Testing Information
Colonization Screening Resources
Contact

MDH Admission Screening Recommendations

MDH strongly recommends that, on admission, all Minnesota hospitals screen patients with the following exposures to detect both CPOs and C. auris:

• Overnight stay in a health care facility outside the United States or Canada in the previous 12 months.
• Ambulatory surgery or hemodialysis outside of the United States or Canada in the previous 12 months.
• Inpatient or skilled nursing facility stay in the previous 12 months in areas with documented transmission according to tracking data from the Centers for Disease Control and Prevention (CDC).

Case counts by state are available from CDC:

• CDC: Tracking Candida auris (updated monthly)
• CDC Antibiotic Resistance and Patient Safety Portal: Carbapenem-Resistant Enterobacteriaceae

On August 18, 2021, MDH sent a letter to Minnesota acute care infection preventionists to inform infection control programs of these recommendations and to increase awareness of the MDH Public Health Laboratory testing capacity.

• CPO and C. auris Admission Screening Recommendations (PDF)

Laboratory Testing

The MDH Public Health Laboratory (MDH-PHL) is one of seven labs in CDC's Antibiotic Resistance Laboratory Network (AR Lab Network) to receive funding support for enhanced capacity to detect and respond to emerging antimicrobial resistant threats, including CPOs and C. auris. One effort of the AR Lab Network is laboratory testing to detect colonization with CPOs and C. auris. The MDH-PHL supports colonization testing by:

• Providing health care facilities with specimen collection swabs and accompanying instructions
• Laboratory testing of swabs
• Reporting results quickly so that facilities can take action

Specimen Collection and Testing Information

CPO Screening

• Specimen source: Rectal swab using the Copan™ Transystem dual swab
• Testing method: Cepheid® Xpert® Carba-R assay
  • This assay is FDA-approved and detects the five most common carbapenemases (KPC, NDM, OXA-48, VIM, and IMP) by PCR
• Turnaround time: Results are generally available in 1-2 business days

Candida auris Screening

• Specimen source: Bilateral axilla/groin skin swab using the eSwab™
• Testing method: Candida auris real-time PCR
• Turnaround time: Results are generally available in 1-2 business days

Colonization Screening Resources

Please visit Forms for the Infectious Disease Laboratory to access the following Antibiotic Resistance (AR) Laboratory Network resources:

• Copan™ Transystem dual swab, eSwab™, and shipping materials
  • Submit the MDH AR Laboratory Supply Form (Order Supplies, Boxes, Kits from MDH)
• Sampling, handling, and shipping guidance
  • View the Candida auris Sampling and Handling Guidance (PDF) and Carbapenem Resistant Organism (CRO) Sampling and Handling Guidance (PDF)
• ARLN Submission Form (PDF)
  • Submit one form for each swab (rectal and skin)
  • CPO rectal swab: check the "Carbapenem Resistant Organism colonization screening" box
  • C. auris skin swab: check the "Project 2335 Candida auris colonization screening" box

Frequently Asked Questions about Admission Screening for CPO and C. auris Colonization (PDF)
Fact sheet for patients with information about the screening process and why it is important.

Contact

• For laboratory-related questions, please contact the MDH-PHL at arlnmn@state.mn.us or 651-201-5073.
• For epidemiology-related questions, please call 651-201-5414 or 1-877-676-5414 (toll free) and ask to speak with a healthcare-associated infections epidemiologist.