Antimicrobial-Resistant Fungus Spreading At An Alarming Rate, A Threat To ‘Very Sick’ People: CDC

Candida auris is an emerging fungus that poses a serious global threat, and is a matter of concern to the Centers for Disease Control and Prevention (CDC) for three main reasons. 

Candida auris is a yeast, and can enter the bloodstream, spread throughout the body, and cause invasive infections such as bloodstream infections, wound infections, and ear infections.

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An antimicrobial-resistant fungus is spreading at an alarming rate in United States' healthcare facilities, the Centers for Disease Control and Prevention (CDC) announced on March 20, 2023. The fungus, called Candida auris, was rapidly spreading in the healthcare facilities of the country in 2020 to 2021, according to CDC data published in the Annals of Internal Medicine. 

More about Candida auris

Candida auris was first identified in Japan, in the year 2009, and the earliest known strain of the fungus dates to 1996 in South Korea. 

Candida auris is a yeast, and can enter the bloodstream, spread throughout the body, and cause invasive infections such as bloodstream infections, wound infections, and ear infections.

Candida auris is an emerging fungus that poses a serious global threat, and is a matter of concern to the CDC for three main reasons. 

Firstly, Candida auris is often multidrug-resistant, which means that it is resistant to multiple antifungal drugs commonly used to treat Candida infections, with some strains being resistant to all three available classes of antifungals. 

Secondly, it is difficult to identify Candida auris with standard laboratory methods, and it can be misidentified in laboratories without specific technology, leading to inappropriate management. 

Thirdly, Candida auris has caused outbreaks in healthcare settings, because of which it is important to identify the fungus in a hospitalised patient so that healthcare facilities can take special precautions to stop its spread. 

Recent rise in spread of Candida auris

In 2021, the number of cases of Candida auris strains being resistant to echinocandins increased three-fold. Echinocandin is the antifungal medicine most recommended for treatment of Candida auris infections. 

Who is Candida auris a threat to?

According to the CDC, Candida auris is not a threat to healthy people, but to those who are "very sick", use "invasive medical devices", or have "long or frequent stays in healthcare facilities". These people are at increased risk of acquiring Candida auris. 

Why has CDC deemed Candida auris an urgent antimicrobial-resistance threat?

Since Candida auris is often resistant to multiple antifungal drugs, spreads easily in healthcare facilities, and can cause severe infections with high death rates, the CDC has deemed the fungus an urgent antimicrobial-resistance threat. 

In a statement released by the CDC, Dr Meghan Lyman, lead author on the paper, said the rapid rise and geographic spread of cases is concerning and emphasises the need for continued surveillance, expanded laboratory capacity, quicker diagnostic tests, and adherence to proven infection prevention and control. 

When was Candida auris first reported in the US? What are the statistics of its cases?

Candida auris was first reported in the United States in 2016. Since then, the fungus has spread in the country, the article said. 

A total of 3,720 clinical cases have been reported through December 31, 2021. These are the cases in which Candida auris infection is present. As many as 7,413 screening cases have been reported through the same date. These are the cases in which the fungus is detected but not causing infection. 

Each year since 2016 has seen a rise in clinical cases, with the most rapid rise occurring during 2020-2021. 

The cases of Candida auris increased in 2022 as well.

As many as 17 states of the United States identified their first Candida auris case ever during 2019 to 2021. 

From 2019 to 2021, clinical cases all over the nation increased from 476 to 1,471. 

From 2020 to 2021, screening cases increased three-fold. There were 4,041 screening cases in 2021. 

Why is screening of Candida auris important?

In order to identify patients carrying Candida auris, screening must be performed. This is beneficial because in case infection is identified, the transmission of the fungus can be prevented through measures. 

What are the reasons behind the increase in Candida auris case counts?

Poor general infection prevention and control (IPC) practices in healthcare facilities is one of the reasons behind the increase in Candida auris case counts. Also enhanced efforts to detect cases, including increased colonisation screening, could be one of the reasons behind increased case counts.

According to the CDC, colonisation screening is an infection prevention technique using laboratory testing to identify patients who are colonised with resistant pathogens, and helps prevent the spread of those microorganisms. 

A strain on healthcare and public health systems during the Covid-19 pandemic could have increased the spread of Candida auris. 

Some of the data for the paper was provided by the CDC's Antimicrobial Resistance Laboratory Network. This provides nationwide laboratory capacity to rapidly detect antimicrobial resistance and inform local responses to prevent the spread of pathogens and protect people. 

The fungal priority pathogen list of the World Health Organization (WHO) also identified Candida auris as a priority globally.