Wednesday, July 25, 2018

CDC Update: Candida Auris - July 2018


Just over two years ago (June 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.

As the CDC explains in their 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.
Yesterday the CDC updated their C. Auris surveillance page, where they show - as of June 30th  - 340 confirmed cases and 29 probable cases, across 11 states.

Additionally, based on targeted screening in four states reporting clinical cases, the CDC reports an additional 643 patients have been discovered to be asymptomatically colonized with C. auris
An increase of more than 13% over the previous month.
While the numbers remain relatively small, they are undoubtedly significantly under reported, both here in the United States, and around the world.  From the latest CDC update:

  • Single cases of C. auris have been reported from Australia, Austria, Belgium, Malaysia, the Netherlands, Norway, Russia, Singapore, Switzerland, and the United Arab Emirates.
  • Multiple cases of C. auris have been reported from Canada, China, Colombia, France, Germany, India, Israel, Japan, Kenya, Kuwait, Oman, Pakistan, Panama, Saudi Arabia, South Africa, South Korea, Spain, the United Kingdom, the United States (primarily from the New York City area, New Jersey, and the Chicago area) and Venezuela; in some of these countries, extensive transmission of C. auris has been documented in more than one hospital.
  • U.S. cases of C. auris have been found in patients who had recent stays in healthcare facilities in India, Kuwait, Pakistan, South Africa, the United Arab Emirates, and Venezuela, which also have documented transmission.
  • Other countries not highlighted on this map may also have undetected or unreported C. auris cases.
 Some past blogs include:
Notes from the Field: Surveillance for Candida auris — Colombia, September 2016–May 2017)

ECDC: C. Auris Rapid Risk Assessment For Healthcare Settings - Europe

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

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