Detection of Candidozyma (formerly Candida) auris from ward wastewater during an outbreak using culture and molecular methods
Bibliographic record
Abstract
BACKGROUND: Candidozyma (Candida) auris is a multi-drug-resistant fungal pathogen associated with protracted, costly hospital outbreaks. Conventional patient-level screening is resource-intensive and may not be cost effective. Wastewater surveillance may offer a pragmatic, ward-level approach to early detection. AIMS: To determine whether C. auris can be reliably detected in ward wastewater during an ongoing hospital outbreak; to compare the performance of culture- and PCR-based wastewater methods with patient-level colonization screening. METHODS: Between August and September 2024, during an ongoing C. auris UK hospital outbreak, a point-prevalence survey was conducted alongside sampling of 12 corresponding ward sluices. Wastewater grab samples and environmental swabs from sluice sinks, macerators and handwash sinks were investigated by direct culture and enrichment broth, as well as AurisID® real-time PCR assay on the centrifuged pellet. Whole-genome sequencing was performed on matched patient and wastewater isolates to assess genetic relatedness. FINDINGS: Using the detection of ≥1 C. auris patient on a ward as the standard, sensitivity of culture was 75% (95% confidence interval (CI) 35-97%) and specificity 100% (95% CI 40-100%); AurisID® PCR sensitivity was 100% (95% CI 63-100%) and specificity 75% (95% CI 19-99%). Whole-genome sequencing analysis demonstrated clustering and clonality of wastewater and patient isolates (<10 single-nucleotide polymorphisms difference). CONCLUSION: We report the first detection of C. auris from hospital ward wastewater using culture and PCR. Screening ward wastewater may offer a sensitive, cost-effective alternative to individual patient screening in low-prevalence settings, supporting earlier ward-level detection: prospective, longitudinal studies are needed.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".