Tracking Candida Auris

The fungal infection, Candida auris (C auris), continues to see an increase in incidence rates, with a pronounced increase in cases of 95% during 2020-2021. And over the last 5 years, CDC has tracked cases using the Premier Healthcare database, which is a comprehensive electronic healthcare data repository, and offers insights on hospitalizations.

The CDC’s publication, Emerging Infectious Diseases, recently published data looking at patterns with these patients. From 2017–2022, they examined 192 cases of C auris and offered data on these hospitalizations. For starters, there were 38 (20%) C auris bloodstream infections (BSI).

The authors noted that consistent with treatment guidelines, most BSI hospitalizations involved echinocandin therapy. “Echinocandin use was more frequent for bloodstream (76%) versus nonbloodstream (25%) hospitalizations; median time from first positive culture to echinocandin use was 2 days (interquartile range 1–3 days),” they wrote.

In a previous interview with Contagion, one of this study’s authors, Meghan Lyman, MD, medical officer, Mycotic Diseases Branch, CDC, said there is growing resistance to echinocandins.

According to the investigators, the data also showed patients were exhibiting extensive concurrent conditions and healthcare use.

“Underlying conditions and complications were similar for patients with bloodstream and nonbloodstream C auris and most commonly were sepsis (64%), diabetes (55%), chronic kidney disease (44%), and pneumonia (43%),” the investigators wrote. “Compared with nonbloodstream C auris, bloodstream C auris hospitalizations more frequently involved central venous catheters (CVC) (76% vs. 53%; p = 0.010) and tracheostomies (29% vs. 12%; p = 0.008).

And although there are real public health concerns about this emerging fungal infection, it is important to place this into context of the patient characteristics of patients who are getting infected. C auris is mostly limited to people who are older, have weakened immune systems, are experiencing multiple medical problems, and are either hospitalized or in long-term care nursing facilities (LTCF) where these infections can colonize easily.

When Lyman spoke with Contagion earlier this year, she discussed another, earlier study which was published in the Annals of Internal Medicine, describing the 95% increase as well as the types of patients who are getting diagnosed with C auris.

“People with Candida auris are very sick at baseline and require high acuity care,” said Lyman. “These are patients who are on ventilators, have invasive medical devices like central lines, feeding tubes, urinary catheters. They've often had exposure to many antibiotics and antifungal medications. And they've often had long or frequent stays in healthcare facilities. Generally, healthy people are considered low-risk for getting Candida auris and there’s not evidence that transmission in the community is a concern. Transmission mostly occurs in healthcare settings.”

In this most recent study, the investigators also estimated the crude mortality rate was 34%. Higher mortality rates for C auris patients has been established in previous studies.

“These findings underscore the continued need for public health surveillance and C auris containment efforts,” the authors wrote.

Specifically, Lyman says the keys to stem colonization and further spread are comprehensive testing and infection prevention control measures.