CDC Update: Candida Auris - July 2017

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Last summer (June 24th, 2016) the CDC issued a Clinical Alert to U.S. Healthcare facilities about the Global Emergence of Invasive Infections Caused by the Multidrug-Resistant Yeast Candida auris.

C. auris is an emerging fungal pathogen that was first isolated in Japan in 2009. It was initially found in the discharge from a patient's external ear (hence the name `auris').  Retrospective analysis has traced this fungal infection back over 20 years.

A week later we saw a release from the UK's PHE On The Emergence Of Candida auris In The UK, where they detailed a large (and ongoing since April 2015) nosocomial outbreak at an adult critical care unit in England.

Over the past year the CDC and others have been monitoring an increasing number of cases (and hospital clusters) in the United States and abroad, generally involving bloodstream infections, wound infections or otitis.

• Two months ago, in MMWR: Ongoing Transmission of Candida auris in Health Care Facilities, we learned that the U.S. case count had jumped from 7 last summer, to 77 clinical cases, along with 45 `close contacts' of known cases who - while asymptomatic - were positive for C. auris isolated from one or more body sites.  
• Last month, that number had jumped to 86 clinical cases, and colonized asymptomatic cases has increased to 70.

Since the last update, the CDC has also released a new  Fact Sheet on Candida auris – Download[PDF – 2 pages], and has  updated  their recommendations on identification, treatment, and infection control.

Yesterday the CDC updated their C. Auris surveillance page, where they show 98 cases reported across 8 states, and the number of colonized asymptomatic cases has risen to 110.

Given the relatively recent awareness of this nosocomial threat, and how difficult it can be for labs to differentiate between C. auris and other, more common, Candida strains, these numbers likely under represent the true incidence of this emerging pathogen.

Candida auris

Case Count Updated: July 14, 2017

Candida auris is an emerging fungus that presents a serious global health threat. Healthcare facilities in several countries have reported that C. auris has caused severe illness in hospitalized patients. Some strains of C. auris are resistant to all three major classes of antifungal drugs. This type of multidrug resistance has not been seen before in other species of Candida. Also of concern, C. auris can persist on surfaces in healthcare environments and spread between patients in healthcare facilities. CDC has developed identification, treatment, and infection control recommendations to help prevent the spread of C. auris.

CDC encourages all U.S. laboratory staff who identify C. auris to notify their state or local public health authorities and CDC at candidaauris@cdc.gov.

Location represents the state of C. auris specimen collection. The case counts displayed reflect clinical cases of C. auris (i.e., based on specimens collected in the normal course of care). They do not include patients who screened for presence of C. auris colonization. C. auris has been isolated from an additional 110 patients from healthcare facilities in 3 states where clinical cases were detected.  This map will be updated monthly.

Resources

• General Information about Candida auris
• Recommendations for Identification, Treatment, and Infection control of Candida auris
• June 2016 Clinical Alert: Information for Healthcare Professionals about Candida auris
• Laboratory Submission Information

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Some excerpts from the CDC's new fact sheet on C. auris include:

Fact Sheet

Why is Candida auris a problem? 

• It causes serious infections. C. auris can cause bloodstream infections and even death, particularly in hospital and nursing home patients with serious medical problems. More than 1 in 3 patients with invasive C. auris infection (for example, an infection that affects the blood, heart, or brain) die.
• It’s often resistant to medicines. Antifungal medicines commonly used to treat Candida infections often don’t work for Candida auris. Some C. auris infections have been resistant to all three types of antifungal medicines.
• It’s becoming more common. Although C. auris was just discovered in 2009, it has spread quickly and caused infections in more than a dozen countries.
• It’s difficult to identify. C. auris can be misidentified as other types of fungi unless specialized laboratory technology is used. This misidentification might lead to a patient getting the wrong treatment.
• It can spread in hospitals and nursing homes. C. auris has caused outbreaks in healthcare facilities and can spread through contact with affected patients and contaminated surfaces or equipment. Good hand hygiene and cleaning in healthcare facilities is important because C. auris can live on surfaces for several weeks.

(SNIP)

Scientists are still learning about Candida auris

CDC and public health partners are working hard to better understand C. auris and answer the following questions so that we can continue to help protect people from this serious infection:

• Why is C. auris resistant to antifungal medicines?
• Why did C. auris start causing infections in recent years?
• Where did C. auris originally come from, and why has it appeared in many regions of the world at the same time?
  

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And finally, some of my earlier blogs on this emerging pathogen include:

MMWR: Ongoing Transmission of Candida auris in Health Care Facilities 

MMWR: Investigation of the First Seven Reported Cases of Candida auris In the United States

mSphere: Comparative Pathogenicity of UK Isolates of the Emerging Candida auris