Facility Characteristics of Skilled Nursing Facilities with C. auris Transmission in the State of Maryland from 2019 - 2023.

INTRODUCTION: Candidozyma auris is a multidrug-resistant fungus associated with substantial morbidity and mortality. We examined facility level characteristics associated with C. auris transmission across Maryland skilled nursing facilities (SNFs). METHODS: We conducted a retrospective analysis of all Maryland SNFs from 2019-2023 using linked datasets (LTCFocus; CMS Minimum Data Set; Payroll-Based Journal; Maryland Health Care Commission). The primary outcome was facility-level C. auris transmission. We summarized facility characteristics, examined bivariate associations, and completed a multivariable logistic regression. RESULTS: Among 227 SNFs, 21 (9%) experienced C. auris transmission. Of 17 ventilator facilities, 62% (13/17) had transmission. Transmission was associated with larger facility size (62% vs 31%, p=0.02), higher acuity index (mean 13.6 vs 12.7, p<0.01), higher minority concentration (67% vs 28%, p<0.01), lower family rating of care (85% vs 47%, p<0.01), and higher pressure ulcer prevalence among high-risk long-stay residents (14.6% vs 9.4%, p<0.01). In multivariable analysis (n=218), ventilated facilities (OR 77; 95% CI 14-598) and poorer family rating of care (OR 6.0; 95% CI 1.3-43.2) were independently associated with transmission. CONCLUSION: C. auris transmission in Maryland SNFs was associated with facilities containing ventilated residents and with poor family rating of care and higher burden of pressure ulcers. Targeted screening and infection prevention resources should prioritize ventilator facilities and those with indicators of lower quality of care.