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Candida auris Makes Front-Page News: Public Health Watch

APR 10, 2019 | BRIAN DUNLEAVY
Infectious disease made front-page headlines—literally—this week when The New York Times ran a story on drug-resistant Candida auris on its front page on April 7th. It’s hardly the first time that antibiotic-resistant pathogens have generated headlines, of course, but it may be the first time the topic has received attention on such a big stage.

“I am not surprised but rather relieved that the topic is being given much-needed attention,” Bhagyashri D. Navalkele, MD, medical director of Infection Prevention at the University of Mississippi Medical Center, who has written about the bug, told Contagion®. “It is extremely important to spread awareness on C auris as it continues to rise in [the] US and across the globe.”

In November, Contagion® reported on projections made by the Organization for Economic Co-operation and Development (OECD), which estimate that antibiotic-resistant pathogens like C auris could kill 10 million people globally by 2050.

However, even these doomsday scenarios, which (rightfully) resulted in similarly panicked (though not front-page) media coverage globally, arguably pale in comparison to the clinical Catch-22 described in the Times’ story. Indeed, the self-proclaimed paper of record begins its coverage with the tale of an elderly male patient who checks into a Brooklyn hospital, seriously ill. Blood tests confirmed C auris and, despite aggressive treatment, the patient succumbed to the infection 3 months later.

And yet, it is in the patient’s death that the story gets really interesting—at least to your average reader. That’s because the patient’s infection doesn’t die with him. In fact, as the newspaper notes (with confirmation from hospital administrators), “Tests showed it was everywhere in his room, so invasive that the hospital needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it.”

Thankfully, the US Centers for Disease Control and Prevention (CDC) has been tracking C auris cases since 2016, when the bug first began to surface. To date, there have been 617 confirmed cases across the United States, with New York, New Jersey, and Illinois showing the highest incidence. However, it’s important to emphasize that experts and officials at the CDC don’t see the bug so much as a problem of the present but rather one of the future, albeit the all-too-near future. Hence, the agency has released guidance on the diagnosis and treatment of C auris.

“Unique characteristics of C auris make it a serious and challenging global health threat [and] it continues to be poorly recognized cause of infection among healthcare providers,” Navalkele said. “C auris is a tricky fungus as it mimics other less harmful Candida species, causing a delay in identification and management. It can affect any age group, and is known to be very difficult to treat due to multidrug resistance; [thus], it is associated with high mortality and transmission risk resulting in outbreaks.”
Part of the management of this “superbug” may eventually include the novel agent ibrexafungerp, and, perhaps not surprisingly, the manufacturer of the drug, which is in Phase III clinical trials, has weighed in on the coverage in the Times.

“We at SCYNEXIS understand the significant threat that Candida auris poses to human health and we believe that our lead investigational drug product, ibrexafungerp, can play a major role in combating this growing, global, public health threat,” Marco Taglietti, MD, SCYNEXIS president and CEO, said in a statement released the day after the newspaper story. “We remain committed to developing ibrexafungerp to treat this new, often multidrug-resistant Candida species and stand ready to do our part to assist the global community in responding to this public health threat.”

And on that front, there is news to report. Ibrexafungerp has already demonstrated efficacy in the aforementioned Phase III trial, which is still enrolling patients, and new data will be presented in the coming days during the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID). A poster to be presented at the meeting chronicles the successful treatment of 2 cases of C auris with the new drug.

For Navalkele and others, though, the coverage in the Times isn’t just about a possible solution to a clinical challenge, but about raising awareness that the problem exists. “ID and public health professionals should take advantage of this opportunity to raise awareness and demand firm global action plans from world health leaders,” Navalkele told Contagion®. “Emphasis on prevention efforts such as stricter laws to help restrict antimicrobial usage, through widespread stewardship measures, and improved infection prevention efforts, especially environmental cleaning practices in healthcare facilities, should take priority to fight this threat.”
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