Officials from the Centers for Disease Control (CDC) have issued a formal warning regarding the spread of the drug-resistant Candida auris fungus. This drug-resistant organism has been spanning the globe over the past 10 years, but has lately been making the rounds in major cities in the United States. The majority of cases in the US have been in New York, New Jersey and Illinois, with more in California, Florida and a few other states. Here’s what you need to know to protect yourself from this hospital-borne infection...
Let’s start with a clarification. Many people have heard of, and are more familiar with, the Candida albicans fungus. Candida albicans is a fungal organism that exists naturally within the human gut. Most people do not have trouble with this particular organism unless they are immunocompromised. The use of antibiotics and other medications can cause imbalances in the gut, allowing an overgrowth of the Candida albicans organism. This can lead to gastrointestinal distress, skin irritation and genital yeast infections, among other issues.
The Candida auris (C. auris) organism, on the other hand, is a lesser understood species of Candida. While this particular strain is rare, it can live in or on the human body without making people sick. This form of Candida can be particularly aggressive and invasive in those with severely compromised immune systems, entering the bloodstream and causing fevers, sepsis, coma, organ failure and in some cases death.
The C. auris fungus was first identified in Japan in 2009 and reached the US in 2013. The most recent outbreak seems to have spread to the United States in May of 2018, after a surgical patient at the Mount Sinai Hospital branch in Brooklyn, New York presented with a new infection post-surgery. The fast-moving organism can live on the skin, making it easy to transfer from person to person, especially in healthcare settings where medical staff may unknowingly carry it from room to room.
The Mount Sinai patient died after 90 days in the hospital. According to The New York Times, testing in his room revealed the organism had spread to almost all surfaces. The hospital ended up having to go as far as ripping out ceiling and floor tiles during its efforts to disinfect the room.
There are two main challenges when it comes to the C. auris organism. The first is that it is incredibly difficult to detect, as it does not show in regular blood tests. A medical professional must suspect the infection so that advanced laboratory testing and technology can be used to look for the organism. The symptoms associated with C. auris mimic other infections, often resulting in misdiagnosis and improper treatment protocols. This problem is further complicated by the fact that most patients are already seriously ill with other conditions at the time of infection and diagnosis.
The second challenge is that C. auris is resistant to the antifungal medications most often used to treat Candida strains. There are 3 main antifungal drug classifications. Echinocandins have been most successful at treating this specific germ, but even this type is not successful in all cases. The CDC claims that “more than 90% of C. auris infections are resistant to at least one drug, and 30% are resistant to two or more drugs.” In many instances, doctors end up having to combine multiple antifungal drugs, resorting to very high doses to get the desired effect.
Anyone with a compromised immune system is at risk of developing a C. auris infection. These include people who have:
Colonisation is the term used to describe individuals who carry the C. auris germ but are not made ill by it. Researchers have found there is no benefit to treating carriers who do not show signs of infection. They actually believe that treating those without symptoms with antifungal medications could increase the organism’s resistance to medications or increase the carrier’s risk of developing an infection later on.
According to the Council of State and Territorial Epidemiologists (CSTE), C. auris infections have had an in-hospital mortality rate of up to 40%, with most patients dying within 90 days of infection. It is important to note, again, that the majority of people who develop this invasive infection already have major health conditions.
Patients who are diagnosed with C. auris are isolated. Healthcare providers and visitors must take precautions, including wearing protective gowns and gloves and using hand sanitizers before entering and leaving. Visitors should not bring food or beverages into an infected patient’s room, and will not be permitted to visit other hospital patients on the same day.
If you yourself have been diagnosed, do your best to avoid touching any open wounds you already have. You must take particular care when washing your hands after going to the bathroom and before meals. Do not leave your room without notifying a healthcare professional first.
Once you are discharged, you’ll need to continue practicing good hygiene. Don’t forget to wash your hands before preparing food or touching any of your home medical equipment. Do not share towels or washcloths, and keep any wounds you have covered at all times.
Truly controlling the spread of C. auris will require conscious monitoring, early detection and the proper implementation of infection control protocols. Keep the following in mind and speak to a healthcare provider immediately if you suspect you or a loved one may be infected:
The CDC does not feel family members of those with C. auris need to be tested for the infection, as doing so may lead to unnecessary treatment in individuals with no symptoms. Despite this, be sure to talk to your healthcare professional if you are concerned about your exposure and risk factors, especially if you are a caregiver or work in a healthcare environment.
~ Here’s to Your Health and Wellness