Candida Auris: An Emerging Fungal Infection That Warrants Our Attention
This infection has the ability to remain undetected and the potential to spread very quickly in long-term care facilities and hospitals.
Candida auris was first discovered in 2009 in Japan where a man had it appear in his ear. According to the Centers for Disease Control and Prevention (CDC), a retrospective review of Candida strain collections found that the earliest known strain of the fungus dated back further to 1996 in South Korea.
The Centers for Disease Control and Prevention (CDC) has outlined 3 main concerns about the infection, including: It is often multidrug-resistant; It can be challenging for labs to diagnose with standard laboratory methods, which can lead to misidentification and in turn lead to the incorrect treatment and management; And, it can quickly lead to outbreaks in health care facilities.
"Most strains of C auris found in the United States have been susceptible to echinocandins although reports of echinocandin- or pan-resistant cases are increasing. This organism appears to develop resistance quickly. Patients on antifungal treatment should be carefully monitored for clinical improvement. Follow-up cultures and repeat susceptibility testing should be conducted. Both recurrent and persistent C. auris bloodstream infections have been documented," the CDC stated on its website. (1) Image Credit: Stephanie Rossow
Hospitals and long-term care facilities have been vulnerable, especially for patients who are medically fragile and are dealing with acute health issues.
Infection prevention (IP) measures are key strategies when trying to avoid further transmission. Along with cleaning and hygiene measures, 1 IP team at UCLA implemented a Candida auris risk assessment in the admissions screening, EMR-related strategies, and education to the clinical teams on emerging organisms and high-risk factors.
Since it was first diagnosed in 2009, Candida auris has spread through 6 continents, and has had multiple outbreaks. The fungal infection is often multidrug resistant and can be associated with a high mortality rate.
Here is an interview with a clinician who speaks about various components of it, including how diagnosing it is evolving, the merits of monotherapy over combination therapy, what to consider in seeing resolution of symptoms, and some of the big picture public health concerns associated with this infection.
In the United States, C auris has gone from a few isolated outbreaks to it now being seen in many areas of the country including the west, midwest, south, and northeast.
Earlier this year, there were 2 outbreaks in the US. A cluster of 101 cases was detected in a Washington, DC, nursing home and a cluster of 22 cases was detected in 2 Dallas areas hospitals from January to April.
According to reports, some of these patients infected with C auris did not show any clinical improvement after being treated with all 3 major classes of the antifungals. In fact, in 5 patients who were fully resistant to treatment, 3 of them died.
When C auris began surging in Southern California in March of 2020, a team of infection preventionists at UCLA felt they were prepared to deal with this emerging infection if they saw it at their facilities. In the months that followed, California saw the third highest number of C auris cases in the US behind only New York and Illinois. According to the Centers for Disease Control and Prevention (CDC), the state had 187 clinical cases between June 1, 2020 and May 31, 2020.
The UCLA IP team implemented a Candida auris risk assessment in the admissions screening, as well as EMR-related strategies and education to the clinical teams on emerging organisms and high-risk factors.
In addition to awareness and IP strategies being implemented, there is some ongoing development and studies of antifungal therapies.
The CDC has published some treatment recommendations.1 It remains important to be vigilant and aware of C auris and understanding of treatment hygiene protocols to avoid the spread of this emerging infection.
1. Candida auris Treatment and Management of Infections and Colonization. CDC. Updated July 22, 2021. Accessed November 23, 2021. https://www.cdc.gov/fungal/candida-auris/c-auris-treatment.html