Employee health professionals should be aware of an emerging new multidrug-resistant fungal “superbug,” Candida auris. This pathogen spreads more like bacteria than fungi and can colonize the skin for prolonged periods, the CDC reports.
“We have [patients] who have had it on their skin for nine months, so it seems to be very [capable of] surviving on skin,” says Tom Chiller, MD, MPH, chief of the CDC Mycotic Diseases Branch. “We also know that it survives really well on surfaces, plastic, floors, windowsills, beds, desks. It can clearly survive in the environment and it is also more challenging to kill.”
The CDC is recommending that environmental cleaning workers use powerful sporicidals — similar to what is used for Clostridium difficile — to eradicate C. auris on surfaces. As employee health professionals are well aware, some workers experience adverse reactions to these powerful cleaners, which should be used according to the manufacturer’s instruction in the appropriate dilutions, with adequate personal protective equipment worn by the worker.
Healthcare workers’ hands certainly could be transiently colonized long enough to risk cross-transmission to patients, but they do not need to be tested for C. auris unless they are identified as a possible source of transmission to patients. Likewise, family members of healthcare personnel do not need to be tested for C. auris.
“The risk of C. auris infection to otherwise healthy people, including healthcare personnel, is very low,” according to the CDC.1 “In the United States, C. auris infection has primarily been identified in people with serious underlying medical conditions who have received multiple antibiotics, and who have had prolonged admissions to healthcare settings or reside in healthcare settings. Otherwise healthy people do not seem to be at risk for C. auris infections, but can be colonized on their skin.”
In one CDC investigation of a C. auris outbreak, colonization was detected on the skin of less than 1% of healthcare workers. Colonization was transient on the hands and in the nostrils.
The emerging fungus was first reported as the etiologic agent of an ear infection — hence, the auris name — in 2009 in Japan. C. auris now has been identified in other parts of Asia, Africa, South America, and the United Kingdom. In the U.S., as of Aug. 31, 2017, 153 clinical cases of C. auris infection have been reported to the CDC from 10 states, with most occurring in New York and New Jersey. In addition to the infected patients, another 143 were found to be colonized with C. auris based on targeted screening.
The CDC emphasizes that recommended infection control measures are the same for both infection and colonization with C. auris, meaning asymptomatic carriers would also be placed in contact precautions. As with other multidrug-resistant pathogens, patients may be colonized for months. Presently, there is little guidance on decolonization or removing isolation protocols.
1. Centers for Disease Control and Prevention. Candida auris Questions and Answers for Healthcare Personnel. Available at: http://bit.ly/2qHjA5x. Accessed Oct. 2, 2017.