CDC Issues Warning About Multidrug-Resistant Candida Species

In a recent clinical alert, the Centers for Disease Control and Prevention (CDC) warned US healthcare facilities about Candida auris, an emerging multidrug-resistant (MDR) yeast that is causing severe, and sometimes fatal, healthcare-associated infections.

Candida auris is invasive and causes a wide range of infections, including in the bloodstream, wounds, and ears. It affects patients of all ages and is most commonly associated with hospital-acquired infections. It tends to occur several weeks into a hospital stay, and according to the CDC, “is associated with high mortality”. It also has high potential to cause outbreaks of infection in healthcare facilities, the alert states. At least two countries have reported such outbreaks in healthcare facilities, each involving more than 30 patients.

The yeast was first described in 2009 in Japan, in a patient with an ear infection. Since then, invasive infections have also been reported in patients in South Korea, India, South Africa, and Kuwait. Unpublished cases of C. auris infection have also been documented in Colombia, Venezuela, Pakistan, and the United Kingdom. According to the CDC, one isolate was also detected in the United States in 2013 during ongoing surveillance.

Identification of C. auris in the laboratory is problematic, in part because tests that are currently used to identify yeasts cannot distinguish this particular organism from similar, related yeasts. This has led to misidentification of the yeast, as well as inappropriate treatment of infected patients.

Of particular concern, however, is that most strains of C. auris are resistant to one, two, or three of the major classes of antifungal agents (azoles, echinocandins, and polyenes), thus limiting the available options for effective treatment of C. auris infections.

“Given the occurrence of C. auris in nine countries on four continents since 2009, CDC is alerting U.S. healthcare facilities to be on the lookout for C. auris in patients,” the report stresses.

If C. auris infection is suspected in a patient, the CDC advises that healthcare facilities should report the case to state and local public health authorities, as well as the CDC; laboratories that identify C. auris infection should also notify these authorities. Healthcare facilities should place infected patients in single isolation rooms, in order to control the spread of infection. And because C. auris is considered to persist in the environment, the CDC recommends thorough daily and terminal cleaning of the patient’s room using a US Environmental Protection Agency-registered hospital grade disinfectant that is effective against fungi.

Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals, and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee.