The State of Candida Auris

Multiple strains of Candida auris called clades have emerged independently in various parts of the world and can successfully pass from patient to patient once introduced into a health care facility, according to a clinical update published in JAMA Insights.

Study author Suzanne F. Bradley, MD from the Department of Internal Medicine at the University of Michigan Medical School laid out what is currently known about C auris so that clinicians can be alert for the presence of this growing threat. Because it might be present at their facilities, she wrote, clinicians need to be aware of their location’s infection control policy to alert the appropriate personnel.

“The spread of C auris through the environment from patient to patient is the biggest concern,” Bradley told Contagion®. “If patients do develop severe infections with C auris, treatment options may be few.”

For example, all confirmed C auris isolates must be immediately reported to the US Centers for Disease Control and Prevention (CDC) and local health departments, as well as the facility’s infection control personnel. Patients with confirmed or suspected C auris should be placed in a private room with standard and contact precautions in place, including adherence to hand hygiene, the use of gowns, gloves, and designated equipment. Daily disinfection is paramount; chlorine bleach or hydrogen peroxide vapor appear to be the 2 most effective agents based on the results of small studies, Bradley said.

Through June 30, 2019, there have been 725 confirmed and 30 probable cases of C auris, mostly in hospitals and nursing homes in New York City, New Jersey, and Chicago. However, sporadic cases have been identified in 9 other states and involve up to 4 different clades. According to Bradley, this suggests that patients from other countries sought care inside US facilities since a patient can be asymptomatically colonized for up to 3 months.

Additionally, Bradley wrote that C auris may be viable on plastic devices for up to 14 days and moist surfaces for up to 7 days. Some common contamination sites can include furniture, catheters, and reusable equipment such as infusion pumps and temperature probes.

The mortality rate for C auris, which can cause severe invasive infection in some patients, ranges from 30% to 60%. About 40% of C auris isolates will be resistant to 2 or more drug classes, while 10% of isolates will be resistant to all antifungal drugs. Almost all of the C auris isolates in the United States are resistant to fluconazole, which means they are also likely resistant to other azoles, while 30% are resistant to amphotericin. Just 5% of C auris isolates are resistant to echinocandins, so these drugs are recommended for empirical management of infection, Bradley wrote.

“Many laboratories just report ‘yeast’ on results of cultures,” Bradley said. “Clinicians who are concerned that their patients might have C auris need to insist that laboratories identify yeast as fully as possible or refer the isolate to a lab who can. That way, the clinician knows if it is a yeast that is likely to be resistant to antifungals or may be spread to other patients. Fortunately, most yeast do not require treatment or are easily treated and don’t spread from person to person.”

The CDC suggests rescreening patients with C auris at 3-month intervals, and that 2 negative cultures taken 1 week apart while the patient is not receiving systemic and topical antifungals might suggest discontinuing the isolation period.

Until information about successful disinfection agents is understood, “all clinicians should be aware that this pathogen might be present in their facility, and they should notify their facility’s infection control personnel quickly when C auris is suspected,” Bradley concluded.