CDC Updates Guidance as Candida auris Cases Grow

Marcia Frellick

October 05, 2017

SAN DIEGO — The number of cases of Candida auris is on the rise in American healthcare facilities, and the Centers for Disease Control and Prevention (CDC) is asking laboratories to determine the species when a result for Candida is positive and C. auris is suspected.

C. auris represents a paradigm shift, Tom Chiller, MD, from the mycotic diseases branch of the CDC, told the audience during a late-breaking session here at IDWeek 2017.

"It's a yeast that's acting like a bacteria," which should change the way we think about fungi, he explained. "I never really thought, as a mycologist, that I'd be talking about a fungal superbug, but unfortunately I am," said Dr Chiller.

Cases of C. auris were identified in the United Kingdom when the fungus began spreading among patients. Containing it was such an issue that the intensive care unit (ICU) had to be shut down

"In my life, I hadn't heard of an ICU being shut down for a fungus," said Dr Chiller. "That really got our attention."

After that outbreak, the CDC began analyzing cases in the United States. The first clinical alert was issued in June 2016.

C. auris has now been reported in 10 states, where 126 cases have been confirmed cases and 27 cases are considered probable.

I never really thought, as a mycologist, that I'd be talking about a fungal superbug, but unfortunately I am.

"This time last year, we knew of about six or seven cases," said Sharon Tsay, MD, also from the mycotic diseases branch of the CDC, who presented a poster on the response to the outbreaks.

Table. Confirmed Cases of C. auris

State Number of Confirmed Cases
New York 86
New Jersey 26
Illinois 4
Massachusetts 3
Florida 2
California 1
Connecticut 1
Indiana 1
Maryland 1
Oklahoma 1

 

In addition to the 153 probable or confirmed cases, about 140 people have been colonized and "have C. auris on them and could spread it," Dr Tsay told Medscape Medical News.

The fungus thrives in hospital environments and has been found on the bottom of shoes, hospital floors, sanitizing dispensers, and chairs. And "it's very content to stay there," said Dr Chiller.

The Challenge in New York

In New York, the hardest-hit state, "they know it's set up shop in some facilities. They're really working hard to try to understand how widespread it is and, once it is identified, how it can be contained," he told Medscape Medical News.

That's a huge challenge in New York, given the large number of long-term acute-care facilities, where there are fewer physicians and fewer experts in infection control, he explained.

And the classic disinfectant, ammonia — or "hospital holy water," as Dr Chiller called it — does not work on this fungus.

"It doesn't kill. You have to use bleach," he said.

CDC Clinical Update

The latest CDC clinical update, released at the end of September, highlights the need for labs to identify the species of Candida when there is suspicion of C. auris, when the patient has received healthcare in a country with known outbreaks, or when the patient might have had exposure in the United States, Dr Tsay said.

Labs should look for Candida from any body site, including urine, not just the bloodstream.

The fungus presents particular challenges because it is hard to identify, it's easily transmitted, and it can grow on skin, which makes it different from typical yeast. It is also resistant to multiple antifungals, not necessarily typical of Candida, and it can be deadly.

Thirty-day mortality for the fungus — including all-cause mortality — is about 30%, "which is comparable to other Candidas," Dr Tsay reported.

C auris is most commonly mistaken for the rare Candida haemulonii, she added.

"If we ever see C. haemulonii causing infection in humans, it's usually in a wound, like on a foot," she explained "When we see C. haemulonii pop up in the blood or in the urine, we are suspicious that it may be C. auris because it shouldn't be there."

Because candidemia is an autoinfection — "the source is your own gut" — outbreaks of Candida have been exceedingly rare, said Dr Chiller.

It is a substantial problem in hospitals, and is the most common healthcare-associated bloodstream infection, according to the latest CDC study.

Multiple C. auris infections have also been documented in Colombia, India, Israel, Kenya, Oman, Pakistan, Panama, South Korea, South Africa, Spain, and Venezuela.

Dr Tsay and Dr Chiller have disclosed no relevant financial relationships.

IDWeek 2017. Poster 144, presented October 5, 2017. Late breaker 004, presented October 4, 2017.

Follow Medscape on Twitter @Medscape and Marcia Frellick @mfrellick

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