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Illinois Department of Public Health Warns of Multidrug-Resistant Fungus Candida Auris Causing Healthcare-Associated Infections Worldwide

Wed April 10 2019 4:44 pm
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First described by Japanese scientists in 2009 after it was isolated from the external ear canal of an inpatient in a Japanese hospital, Candida auris has since made its appearance in more than a dozen countries on five continents (Medscape video from October 17, 2018).

The Illinois Department of Health (IDPH) published an alert Tuesday April 9, 2019 that there is an emerging multidrug-resistant fungus called Candida auris (C. auris) that is causing healthcare-associated infections around the world, including the U.S. and in Illinois. Recent media attention is raising awareness of this multidrug-resistant fungus. While this infection is still rare in the United States and most people are at low risk of getting infected, IDPH is committed to ensuring Illinoisans and health care providers have the tools they need to stay safe.

“Our top priority at IDPH is keeping Illinoisans healthy and safe and we are working hard to ensure residents have the information and resources they need in response to all emerging health threats,” said IDPH Director Dr. Ngozi Ezike. “Fungal infections caused by C. auris, and similar infections, have the potential to cause serious illness, are often resistant to standard medications, and continue to spread in health care settings. There are steps physicians, health care facilities, and individuals can take to avoid infection and prevent the spread of disease, and IDPH encourages all Illinoisans to get educated and stay safe.”

IDPH and local health departments are working with health care facilities to implement and maintain infection control practices to reduce transmission (cleaning and disinfecting environmental surfaces and shared equipment, hand hygiene, gloves, gowns, etc.). Public health officials are conducting surveillance for clinical cases and also screening individuals (swabbing the skin of patients/residents) in health care facilities where clinical cases have been found. These steps allow us to identify patients who may have come in contact with C. auris. In an effort to reduce further spread, public health officials have been in more than 100 health care facilities to actively investigate every clinical case to identify any possible exposures.

Why is CDC concerned about C. auris infections?
CDC is concerned about C. auris for three main reasons:

It is often multidrug-resistant, meaning that it is resistant to multiple antifungal drugs commonly used to treat Candida infections.

It is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology. Misidentification may lead to inappropriate management.

It has caused outbreaks in healthcare settings. For this reason, it is important to quickly identify C. auris in a hospitalized patient so that healthcare facilities can take special precautions to stop its spread.

There are steps individuals can take when receiving medical treatment, whether it is in a hospital, a long-term care facility, or a clinic to help protect themselves from infection.

When a doctor, nurse, or other health care worker enters the room, observe as they clean their hands.

Patients and loved ones should make sure their hands are clean as well.

Patients should feel comfortable inquiring if medical equipment was cleaned after being used on another patient (e.g. stethoscope or blood pressure cuff).

Check if the room and surfaces have been cleaned with the appropriate disinfectant

Ask what steps the facility is taking to reduce the transmission of healthcare-associated infections.

People who get C. auris or other Candidal infections are often patients sick from other medical conditions. There is increasing evidence that the spread of C. auris may be particularly high in post-acute and long-term care facilities, especially long-term acute care hospitals and skilled nursing facilities that take care of patients on ventilators. Patients at higher risk for developing C. auris infection are those who require invasive medical care, including ventilators for breathing support, feeding tubes, central venous catheters, and also broad-spectrum antibiotics.

Symptoms of C. auris infection may not differ from those of other infections, and they vary depending on the part of the body that is infected. People can also have C. auris on their body without developing an infection or any symptoms. Even without symptoms, it is possible to pass C. auris to other people. People concerned that they may have a fungal infection or healthcare-associated infection should talk to their health care provider immediately.
C. auris can be highly resistant to antifungal drugs, meaning that medications used to treat Candidal infections often do not work against it. However, most C. auris isolates in Illinois have been treatable with all antifungals.

IDPH has provided clinical alerts to hospitals, providers, and laboratories – providing guidance on testing, patient management, and appropriate infection control recommendations.

IDPH continues to work diligently to educate health care facilities, physicians, and individuals about the judicious use of antimicrobials and actions that can help prevent the spread.

Where Was C. Auris First Reported?

C. auris was first identified in 2009 in Japan. Retrospective review of Candida strain collections found that the earliest known strain of C. auris dates to 1996 in South Korea. CDC considers C. auris an emerging pathogen because increasing numbers of infections have been identified in multiple countries since it was recognized.

CDC conducted whole genome sequencing of C. auris specimens from countries in the regions of eastern Asia, southern Asia, southern Africa, and South America. Whole genome sequencing produces detailed DNA fingerprints of organisms. CDC found that isolates within each region are quite similar to one another, but are relatively different across regions. These differences suggest that C. auris has emerged independently in multiple regions at roughly the same time.

It is unlikely that routine travel to countries with documented C. auris infections would increase the chance of someone getting sick from C. auris. Infections have occurred primarily in patients who were already in the hospital for other reasons. People who travel to these countries to seek medical care or who are hospitalized there for a long time may have an increased risk for C. auris infection.

Cases of C. auris infections have been reported in the United States. As laboratories continue to look for this fungus, it is likely that more cases will be reported in the United States.

Specific Diagnosis of C. auris

Like other Candida infections, C. auris infections are usually diagnosed by culture of blood or other body fluids. However, C. auris is harder to identify from cultures than other, more common types of Candida. For example, it can be confused with other types of yeasts, particularly Candida haemulonii. Special laboratory tests are needed to identify C. auris.

Is C. auris Fatal?

Invasive infections with any Candida species can be fatal. The CDC doesn’t know if patients with invasive C. auris infection are more likely to die than patients with other invasive Candida infections. Based on information from a limited number of patients, 30–60% of people with C. auris infections have died. However, many of these people had other serious illnesses that also increased their risk of death.

Most C. auris infections are treatable with a class of antifungal drugs called echinocandins. However, some C. auris infections have been resistant to all three main classes of antifungal medications, making them more difficult to treat. In this situation, multiple classes of antifungals at high doses may be required to treat the infection. Treatment decisions should be made in consultation with a healthcare provider experienced in treating patients with fungal infections.

See also …
IDPH | IDPH Encourages Illinoisans to Take Precautions on Emerging Multidrug-Resistant Fungal Infections

CDC | General Information about Candida auris



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