Implementation and Yield of an EHR-Integrated Risk-Assessment Pathway for Targeted Candida auris Admission Surveillance in a Saudi Tertiary Hospital.
7 affiliations
- 1College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- 2Division of Infectious Diseases, Department of Internal Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
- 3Infection Prevention and Control Department, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
- 4Pediatric Infectious Diseases, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
- 5Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- 6Department of Pathology, King Saud Univerity Medical City, Riyadh, Saudi Arabia.
- 7Division of Infectious Diseases, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Abstract
Candida auris is an emerging multidrug-resistant yeast capable of persistent colonisation and healthcare transmission. We evaluated the implementation and microbiological yield of an electronic health record (EHR)-integrated risk-assessment pathway for targeted admission surveillance. This retrospective observational implementation study used prospectively collected admission-screening records linked to microbiology data at a 1,000-bed tertiary hospital in Riyadh, Saudi Arabia, from January 2020 through December 2022. A seven-item nursing PowerForm assigned three points for direct transfer/admission from another hospital and one point for each of six other indicators; scores ≥3 triggered the high-risk pathway. Outcomes included screening coverage, data completeness, high-risk classification and targeted-testing yield. Admissions below threshold were not systematically tested; therefore, diagnostic sensitivity, specificity and negative predictive value were not estimable. The PowerForm was completed for 68,031 admission episodes, with 475,296/476,217 expected item responses recorded (99.81%). The EHR classified 4,082 episodes as high risk (6.00%; 95% CI, 5.82%-6.18%). All 4,082 high-risk episodes in the analytic cohort had a final linked microbiological disposition; however, the extract did not distinguish whether each disposition arose from protocolised surveillance sampling or another clinical microbiology route. Fifty-three unique patients had a first laboratory-confirmed C. auris result, giving an operational targeted-testing yield of 1.30% (95% CI, 0.99%-1.69%), or approximately 77 high-risk episodes evaluated per detected case. EHR-integrated risk assessment was feasible and concentrated score-triggered screening activity on 6% of admission episodes. Because microbiological verification was pathway-dependent, the findings describe implementation yield rather than diagnostic accuracy. Prospective multicentre validation with representative testing across risk categories is required.
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BibTeX
@article{alshahrani2026implementation,
title = {{Implementation and Yield of an EHR-Integrated Risk-Assessment Pathway for Targeted Candida auris Admission Surveillance in a Saudi Tertiary Hospital.}},
author = {Fatimah Saad Alshahrani and Abba Amsami Elgujja and Sara S Alsubaie and Salah Ahmed Ezreqat and Ahmed Albarrag and Khalifa BinKhamis and Lulwa Ibrahim Alabdan and Marytonia Valiyavettil Antony and Jocelyn Cordova Caparoso and Samah M Adam and Khalid Waleed Faqihi and Daifallah H Alshehri and Ghadah A Alamoudi and Mazin Barry},
journal = {Infection and drug resistance},
year = {2026},
month = oct,
doi = {10.2147/idr.s643012},
url = {https://europepmc.org/article/MED/42953397},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Implementation and Yield of an EHR-Integrated Risk-Assessment Pathway for Targeted Candida auris Admission Surveillance in a Saudi Tertiary Hospital.
AU - Fatimah Saad Alshahrani
AU - Abba Amsami Elgujja
AU - Sara S Alsubaie
AU - Salah Ahmed Ezreqat
AU - Ahmed Albarrag
AU - Khalifa BinKhamis
AU - Lulwa Ibrahim Alabdan
AU - Marytonia Valiyavettil Antony
AU - Jocelyn Cordova Caparoso
AU - Samah M Adam
AU - Khalid Waleed Faqihi
AU - Daifallah H Alshehri
AU - Ghadah A Alamoudi
AU - Mazin Barry
PY - 2026
DA - 2026/10/24
JO - Infection and drug resistance
DO - 10.2147/idr.s643012
UR - https://europepmc.org/article/MED/42953397
AB - Candida auris is an emerging multidrug-resistant yeast capable of persistent colonisation and healthcare transmission. We evaluated the implementation and microbiological yield of an electronic health record (EHR)-integrated risk-assessment pathway for targeted admission surveillance. This retrospective observational implementation study used prospectively collected admission-screening records linked to microbiology data at a 1,000-bed tertiary hospital in Riyadh, Saudi Arabia, from January 2020 through December 2022. A seven-item nursing PowerForm assigned three points for direct transfer/admission from another hospital and one point for each of six other indicators; scores ≥3 triggered the high-risk pathway. Outcomes included screening coverage, data completeness, high-risk classification and targeted-testing yield. Admissions below threshold were not systematically tested; therefore, diagnostic sensitivity, specificity and negative predictive value were not estimable. The PowerForm was completed for 68,031 admission episodes, with 475,296/476,217 expected item responses recorded (99.81%). The EHR classified 4,082 episodes as high risk (6.00%; 95% CI, 5.82%-6.18%). All 4,082 high-risk episodes in the analytic cohort had a final linked microbiological disposition; however, the extract did not distinguish whether each disposition arose from protocolised surveillance sampling or another clinical microbiology route. Fifty-three unique patients had a first laboratory-confirmed C. auris result, giving an operational targeted-testing yield of 1.30% (95% CI, 0.99%-1.69%), or approximately 77 high-risk episodes evaluated per detected case. EHR-integrated risk assessment was feasible and concentrated score-triggered screening activity on 6% of admission episodes. Because microbiological verification was pathway-dependent, the findings describe implementation yield rather than diagnostic accuracy. Prospective multicentre validation with representative testing across risk categories is required.
SN - 1178-6973
ER -