Another emerging infection is on the radar.
The latest threat to patient safety comes in the form of a heretofore obscure yeast Candida auris, which has emerged in a multidrug resistant strains in nine countries worldwide, the CDC reports.1
First reported in 2009 in Japan, C. auris has now been identified in other parts of Asia, Africa, South America and the United Kingdom. The pathogen was previously detected in the U.S. in 2013, so there is concern that it will become recurrent given its global presence.
“It is unknown why C. auris has recently emerged in so many different locations,” the CDC states. “Molecular typing of strains performed by CDC suggests isolates are highly related within a country or region but highly distinct between continents. Although the causes for such emergence are unknown, they may include new or increasing antifungal selection pressures in humans, animals, or the environment.”
In some healthcare outbreaks it has caused infections with high mortality in vulnerable patient populations, so infection preventionists should heighten vigilance and cast a wide net in surveillance of suspect organisms.
The pathogen is emerging as a healthcare associated infection in some countries, causing bloodstream infections, and wound infections in patients with underlying conditions like diabetes and the presence of central venous catheters, the CDC reports.
The problem is C. auris can be challenging to identity in the lab or may be confused with other yeast varieties using standard lab methods.
“Commercially available biochemical-based tests, including API strips and VITEK-2, used in many U.S. laboratories to identify fungi, cannot differentiate C. auris from related species,” the CDC states. “Clinical, state, and public health laboratories should be aware of this organism and of the limitations in its identification.”
The news is no better on the antibiotic resistance front, as some strains of C. auris are resistant of as many as three major classes of antifungals drugs. With treatment options limited, infection control basics are a high priority.
“Until further information is available, healthcare facilities should place patients with C. auris colonization or infection in single rooms and health-care personnel should use standard and contact precautions,” the CDC recommends. “In addition, state or local health authorities and CDC should be consulted about the need for additional interventions to prevent transmission.”
Back to Basics
In a nutshell, C. auris is another reason to strive for high compliance with hand hygiene and proper glove use, particularly since the hospitalized patient, at least initially, may not be diagnosed with the infection.
In outbreaks in other countries, the pathogen appears to be able to transmit from environmental surfaces so the CDC is recommending an EPA-registered anti-fungal cleaning agent if C. auris is suspected.
There have clonal outbreaks of as many as 30 patients in some overseas outbreaks, suggesting transmission from patient to patient from transient colonization on the hands of healthcare workers and/or environment surfaces and fomites.
“The precise mode of transmission within the healthcare facility is not known,” the CDC states.
Healthcare facilities with a suspect or confirmed case of C. auris infection should contact state/local public health authorities and CDC at email@example.com.
- Centers for Disease Control and Prevention. Global Emergence of Invasive Infections Caused by the Multidrug-Resistant Yeast Candida auris. June 24, 2016: http://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-alert.html