CDC warns of candida infections that are resistant to anti-fungal treatments.
The Centers for Disease Control and Prevention (CDC) has reported two clusters of Candida auris (fungus) infections that are resistant to anti-fungal medications, and because these pan-resistant infections happened without any exposure to antifungal drugs and were not a result of antibiotic treatment, the cases are especially problematic. The agency indicated, a hard-to-treat infection has been “spreading through nursing homes and hospitals across the United States is becoming even more dangerous.”
The fungus was discovered in Texas both by screening and in samples taken from patients at two separate facilities. “Two were pan-resistant, and five others were resistant to fluconazole and echinocandins,” the announcement indicated. Yet there is no link between the institutions, and the infections occurred at the same time, independently of each other.
“Colonization of skin with C auris can lead to invasive infections in 5%-10% of affected patients,” according to the report. “Routine skin surveillance cultures are not commonly done for candida, although perirectal cultures for vancomycin-resistant enterococci (VRE) and nasal swabs for MRSA have been done for years.” In other words, while routine screenings for other infectious diseases are common, testing for candida is not.
“In the past, about 85% of C auris isolates in the U.S. have been resistant to azoles (eg, fluconazole), 33% to amphotericin B, and 1% to echinocandins,” the agency explained. “Because of generally strong susceptibility, an echinocandin such as micafungin or caspofungin has been the drug of choice for an invasive candida infection. C auris is particularly difficult to deal with for several reasons. First, it can continue to live in the environment, on both dry or moist surfaces, for up to two weeks. Outbreaks have occurred both from hand (person-to-person) transmission or via inanimate surfaces that have become contaminated. Equally troublesome is that people become colonized with the yeast indefinitely.”
“If you wanted to conjure up a nightmare scenario for a drug-resistant pathogen, this would be it,” said Dr. Cornelius J. Clancy, an infectious diseases physician with the VA Pittsburgh Health Care System. “An untreatable fungus infection would pose a grave threat to the immunocompromised, transplant recipients and critically ill patients in the I.C.U.”
Dr. Meghan Lyman, a medical officer at the CDC who specializes in fungal diseases, added, “The concerning thing is that the patients at risk are no longer the small population of people who have infections and are already being treated with these medications.”
The month-long mortality in both outbreaks combined was 30%, according to the CDC. Dr. Michael S. Phillips, chief epidemiologist at NYU/Langone Health, said the focus can’t be exclusively on this new strand, however. He said, “We need to do a better job at surveillance and infection control, especially in places where we put patients in group settings. Candida auris is something we should be concerned about, but we can’t lose sight of the bigger picture because there are a lot of other drug-resistant bugs out there we should be worried about.”