C. auris Screening: Patient Swab Collection

For Health Care Providers

Key points

  • CDC recommends using a composite skin swab of the armpit and groin or other body sites to screen for C. auris, with body-site selection based on laboratory availability.
  • Patient swabs are stored and transported in a test tube containing transport media.
  • Screening decisions are based on factors like potential patient exposure and local epidemiology.
Photo of a healthcare provider holding a swab and test tube

Use of swabs for screening

Importance of screening patients

Screening patients for C. auris colonization is critical for preventing the spread of C. auris. Noninvasive skin swab collection and testing can identify patients who are colonized with C. auris.

CDC recommends using a composite swab of the patient's axilla (armpit) and groin (one swab is used to swab both areas). C. auris has also been isolated from the oropharynx, nares (nostril), external ear canal, hand, vagina, and rectum. Recent data suggest that screening at body sites such as the nares and palms may offer benefits such as more consistent results over time in patients known to be colonized. 12345 Screening methods should be selected based on laboratory availability and implementation logistics.

Facilities determine screening approaches in collaboration with local public health departments based on factors such as potential patient exposure and level of C. auris spread in the area or facility.

Equipment and materials needed

Patient swabs are taken using a culture collection and transport system. One example is the Nylon-flocked swab (BD ESwab collection and transport system; Becton Dickinson and Company, Sparks, MD).A

Procedure for collecting swabs

  1. Open swab package by grasping plastic at opposite end from the soft tip. Leave swab tip enclosed in the package to prevent contamination.
  2. Carefully remove tube from its packaging without touching the soft tip. Use the same swab to:
    1. Swipe all sides of swab tip back and forth 5 times over left axilla skin surface. Target the crease where the arm meets the body. Repeat on the right.
    2. Swipe all sides of swab tip back and forth 5 times over left groin skin surface (inguinal crease in the skin where the leg meets the pelvic region). Repeat on the right.
  3. Remove cap from swab collection tube and place soft end of collection swab into the tube. Prevent cap from touching any materials to avoid contamination.
  4. Snap off end of the swab at the marked line on plastic handle by bending it against the edge of the transport media.
  5. Screw on tube cap, adjusting until snapped end of the swab slides into place in the center of cap.
  6. Follow specific product instructions for labeling, packing, and shipping specimen.
  7. Send or ship immediately to a testing laboratory.B

Specimens can be submitted and tested through CDC's AR Lab Network.

Safety considerations

Use personal protective equipment (gloves and lab coats) when collecting specimens, and practice proper hand hygiene.

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
  1. Mention of a specific commercial product does not qualify as an endorsement of the product by CDC.
  2. This test has not been cleared or approved by the FDA. The performance characteristics have been established by CDC Mycotic Diseases Laboratory.
  1. Hayden, M. K., Dangana, T. E., Yelin, R. D., Schoeny, M., Bell, P. B., II, Stanley, M., Preite, N., Khan, N., Edomwande, O., Black, S. R., Pacilli, M., Huang, X., Deming, C., Lin, M. Y., & Segre, J. A. (2019). 897. Prevalence of Candida auris at body sites, characterization of skin microbiota, and relation of chlorhexidine gluconate (CHG) skin concentration to C. auris detection among patients at a high-prevalence ventilator-capable skilled nursing facility (vSNF) with established CHG bathing. Open Forum Infectious Diseases, 6 (Suppl 2), S25–S26. https://doi.org/10.1093/ofid/ofz359.056
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  4. Sansom, S. E., Gussin, G. M., Schoeny, M., Singh, R. D., Adil, H., Bell, P., Benson, E. C., Bittencourt, C. E., Black, S., Villanueva Guzman, M. D. M., Froilan, M. C., Fukuda, C., Barsegyan, K., Gough, E., Lyman, M., Makhija, J., Marron, S., Mikhail, L., Noble-Wang, J., . . . Hayden, M. K. (2024). Rapid environmental contamination with Candida auris and multidrug-resistant bacterial pathogens near colonized patients. Clinical Infectious Diseases, 78(5), 1276–1284. https://doi.org/10.1093/cid/ciad752
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