Saturday, April 21, 2018

CDC Update: Candida Auris - April 2018


In June of 2016 the CDC issued a Clinical Alert to U.S. Health care 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.
Since then the CDC and public health entities 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.
Adding to the concern:
  1. C. auris infections have a high fatality rate
  2. The strain appears to be resistant to multiple classes of anti-fungals  
  3. This strain is unusually persistent on fomites in healthcare environments.
  4. And it can be difficult for labs to differentiate it from other Candida strains
The CDC has updated their C. Auris surveillance page, where they show - as of March 31th - 247 confirmed cases and 30 probable cases, across 11 states.

Additionally, based on targeted screening in four states reporting clinical cases, the CDC reports an additional 475 patients have been discovered to be asymptomatically colonized with C. auris.

As mentioned, this isn't just a problem in the United States (see map above), and this week the CDC's MMWR carries a `Notes from the field' report on C. Auris in Colombia that illustrates how easily this fungal infection can fly under the surveillance radar. 
Something that is probably happening in many other places around the world.
I've only included some excerpts, so follow the link to read the report in its entirety.

Notes from the Field: Surveillance for Candida auris — Colombia, September 2016–May 2017
Weekly / April 20, 2018 / 67(15);459–460

Patricia Escandón1*; Diego H. Cáceres2,3*; Andres Espinosa-Bode4; Sandra Rivera1; Paige Armstrong2; Snigdha Vallabhaneni2; Elizabeth L. Berkow2; Shawn R. Lockhart2; Tom Chiller2; Brendan R. Jackson2; Carolina Duarte1

After a 2016 CDC alert describing infections caused by the multidrug-resistant fungus Candida auris (1), the Colombian Instituto Nacional de Salud (INS) queried the country’s WHONET† database of invasive Candida isolates to detect previous C. auris infections.
No C. auris isolates were identified during 2012–2016. However, C. auris is often misidentified as Candida haemulonii (2), a yeast that rarely causes invasive infections, and 75 C. haemulonii isolates were reported during May 2013–August 2016.

These isolates came primarily from patients in intensive care units in the country’s north region, approximately 350–600 km (220–375 miles) from Maracaibo, Venezuela, where C. auris cases were first identified in 2012 (3). Of the 75 reported Colombian C. haemulonii isolates in WHONET, INS obtained 45 isolates from six medical institutions dating from February 2015 through August 2016, all of which were confirmed to be C. auris by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry.

Based on these findings, INS issued a national alert and mandated reporting of suspected isolates on August 30, 2016§ (3,4). In September 2016, a team from INS, CDC, and medical staff members from hospitals with documented C. auris cases investigated the 45 MALDI-TOF–confirmed C. auris cases identified before the INS alert. This investigation involved two hospitals in the north region and two in the central region. Cases were clustered within specific hospital units, and surveillance sampling demonstrated transmission in health care settings (INS and CDC, unpublished data, 2018).

Infections caused by C. auris are occurring in Colombia; the pathogen has been present in Columbia since at least 2015, and case counts are increasing. The number of reported cases likely does not reflect the true number of infected and colonized persons because of underreporting and underdiagnosis, as well as misdiagnosis as other yeast species (6).

To contain the spread of C. auris in Colombia, INS updated the C. auris national clinical alert in July 2017 specifying which yeast isolates must be sent to INS for confirmation and mandating that medical facilities implement enhanced infection control practices, including using contact precautions and single rooms for patients with C. auris infections, minimizing the number of health care personnel in contact with infected patients, and daily and terminal cleaning of patient rooms and medical equipment with a disinfectant effective against Clostridium difficile spores** (2).

Clinical laboratories should be aware that automated laboratory systems might incorrectly identify C. auris, particularly as C. haemulonii, although the species reported depends on the system (2).
        (Continue . . . )

For more on this emerging fungal pathogen, you may wish peruse the CDC's dedicated web page:

And for some older blogs on the topic, you may wish to revisit:

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