Candida Auris: Dangerous Fungus Spreading in US Health Care Facilities

On March 20, 2023, the Center for Disease Control issued an urgent press release about the antimicrobial threat, Candidas auris (C. auris). Data published in the Annals of Internal Medicine reported the rapid spread of the fungus in U.S. healthcare facilities from 2019-2021. 

Here is a quick look at the number of U.S. cases over a 4 year period (2008-2021).

• 329 cases reported in 2018
• 467 cases reported in 2019
• 718 cases reported in 2020
• 1,012 cases reported in 2021

The number of cases that were resistant to echinocandins, the medication used to treat the C. auris, tripled in 2021. A Mississippi outbreak that began in November 2022 infected at least 12 individuals and is potentially responsible for 4 deaths. Medicine-resistant fungal infection, C. auris, potentially linked to four deaths in Mississippi - Mississippi Today

What Is C. Auris?

You may be familiar with the term "yeast" infections, which are caused by a type of Candida fungus. C. auris is an emerging new species of Candida that was first identified in 2009 at a hospital in Japan. The fungus has been reported in 30 countries, with the first U.S. case reported in 2016. Infections are likely underdiagnosed and underreported because specialized laboratory equipment is needed to identify C. auris.

Who Is at Risk?

C. auris is most commonly spread to people who live in a nursing home or have had long or frequent hospital stays. It can be found in the body and on skin but is usually not a threat to healthy individuals. However, people with weakened immune systems have an increased risk of infection. Certain conditions are more likely to compromise our immune systems, such as cancers, diabetes and need for frequent antibiotics. The presence of invasive medical devices can also increase vulnerability to C. auris. These devices may include

• Ventilators
• Feeding tubes
• Central lines
• Urinary catheters
• Drains

What Is the Danger?

The CDC considers C. auris an urgent public health threat because it's often resistant to certain medications. In fact, some cases have been resistant to all three types of antifungal medications used to treat yeast. C.auris can also cause serious bloodstream infections and even death. According to the CDC, one in three patients die when the infection spreads to a part of the body that is normally free of pathogens. These areas may include the heart, blood, or brain.

C. Auris spreads easily from person to person or by touching contaminated surfaces or equipment. The fungus can also live on surfaces for several weeks.

What are the Symptoms of C. Auris?

The symptoms of C. auris depend on what part of your body is infected. If the yeast has infected tissue in a wound, the symptoms could be tenderness, drainage, slow healing, and fever. With a bloodstream infection, you may experience fatigue, pain, chills, and fever.

Unfortunately, the signs of C. auris are often missed since the people most likely to be infected are usually dealing with other medical problems.

How Is C. Auris Diagnosed?

C. auris is usually diagnosed through cultures of blood and body fluids. There are unique challenges to diagnosing C. auris. First, not all labs have the special equipment necessary to make an accurate diagnosis. Secondly, it can be difficult to identify C. auris from other types of yeast growth in the culture.

C. Auris Treatment

C. auris is treated with echinocandins, which is an antifungal drug. The drug is given intravenously and works by altering the cell wall of the yeast.

What Is Being Done About C. Auris?

The CDC is working on strategies to slow the spread and prevent future outbreaks. Working in collaboration with partners, the CDC has rolled out the following initiatives:

• Educating healthcare workers and infection control departments on how to stop the spread of C.auris and providing updates as new information is available.
• Working with state and local agencies, healthcare facilities and Microbiology labs to ensure appropriate methods are being used for detection.
• Monitoring emerging C. auris strains for resistance to medications.
• Studying the DNA of different C. auris strains to better understand how it spreads.

Let Us Hear From You

Have you encountered a C.auris case in your practice? What were the barriers, if any, to reaching an accurate diagnosis?