Thirteen cases of Candida auris, a serious and sometimes fatal fungal infection, have been identified in the United States, according to a report from the Centers for Disease Control and Prevention (CDC). Seven of the cases occurred between May 2013 and August 2016 and are described in the latest issue of the CDC’s Morbidity and Mortality Weekly Report. The other six cases were identified after the period covered by the report and are still under investigation.
The report is the first to describe U.S. cases of C. auris infection. C. auris is often resistant to antifungal drugs and tends to occur in hospitalized patients. In June 2016, the CDC issued a clinical alert describing the global emergence of C. auris. The alert requested that laboratories report C. auris cases and send patient samples to state and local health departments as well as the CDC. Since then, the CDC has been investigating reports of C. auris.
“We need to act now to better understand, contain, and stop the spread of this drug-resistant fungus,” said CDC Director Tom Frieden, MD, MPH. “This is an emerging threat, and we need to protect vulnerable patients and others.”
Among the seven cases detailed in the report, patients with C. auris were reported in four states: New York, Illinois, Maryland, and New Jersey. All of the patients had serious underlying medical conditions and had been hospitalized an average of 18 days when C. auris was identified. Four of the patients died; it is unclear whether the deaths were associated with C. auris infection or with underlying health conditions.
In two instances, two patients had been treated in the same hospital or long-term care facility and had nearly identical fungal strains. These findings suggest that C. auris can be spread in health care settings.
Six of the seven cases were identified through a retrospective review of hospital and reference laboratory records. Identifying C. auris requires specialized laboratory methods because it can easily be misidentified as another type of Candida infection, in which case patients may not receive appropriate treatment, according to the CDC. Most of the patient samples in the current report were initially misidentified as another species of Candida.
Most of the C. auris strains from U.S. patients (71%) showed some drug resistance, making treatment more difficult. Samples of C. auris strains from other countries have been found to be resistant to all three major classes of antifungal medications. However, none of the U.S. strains in this report was resistant to all three antifungal drug classes. Based on laboratory testing, the U.S. strains were found to be related to strains from South Asia and South America. However, none of the patients travelled to or had any direct links to those regions. Most patients likely acquired the infections locally.
The CDC recommends that health care professionals implement strict standard and contact precautions to control the spread of C. auris. Facilities should conduct thorough daily and after-discharge cleaning of rooms of C. auris patients with an Environmental Protection Agency-registered disinfectant that is active against fungi. Cases of C. auris should be reported to the CDC and to state and local health departments. The CDC can help in identifying C. auris if needed.
Source: CDC; November 4, 2016.