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Healthcare-associated infection threatens global health

Candida auris on rise in hospitals, acute health centers

Healthcare-associated infections — including central line-, catheter-, ventilator- and surgical site-associated infections — occur most commonly in hospital intensive care units. In the past couple years, healthcare facilities have noted a rise in the yeast Candida auris, which can take to the bloodstream and cause invasive candidiasis — a serious infection affecting multiple organ systems, the bloodstream and wounds. According to the Centers for Disease Control and Prevention, C. auris often demonstrates multidrug resistance against the major classes of antifungal drugs, making it a global health concern.

Using retrospective review, the CDC website cites the first appearance of the yeast as dating back to 1996 in South Korea, with the first known case specifically identifying C. auris occurring about 13 years later in Japan in 2009. Since then, cases have been reported in countries as diverse as Spain, Kenya, India and Canada.

Based on the differences identified between DNA fingerprints of specimens collected from several regions, the CDC found C. auris emerged in multiple locations nearly simultaneously.

Dr. Tom Chiller, chief of the CDC Mycotic Diseases Branch, identifies the emerging pathogen as a “serious global health threat.”

“Healthcare facilities in several countries have reported that C. auris has caused severe illness in hospitalized patients,” Chiller said in an email to The Cavalier Daily. “Some strains of Candida auris are resistant to all three major classes of antifungal drugs. This type of multidrug resistance has not been seen before in other species of Candida. This makes C. auris infections difficult to treat.”

Between the period of May 2013 and February 2017, 53 cases of C. auris were isolated in the U.S. alone, with the majority identified in New York and New Jersey and nearly all taking place from April 2016 to February 2017. No cases have been identified in Virginia.

“We are monitoring for it and, should a case arrive, we will follow the appropriate protocols to prevent it from spreading,” Eric Swensen, public information officer with the University Health System, said in an email statement. “Infection control and prevention is a major focus point for every hospital. We have a wide variety of policies and protocols in place based on recommendations from CDC and other groups that will protect our patients and ensure they receive the safest care possible.”

Clinicians may diagnose cases of C. auris infection using laboratory culture and analysis of body fluids, such as blood or urine. Identification of C. auris infection often proves especially difficult, due to confusion with other types of Candida. Specialized lab tests, such as nucleotide sequencing, may allow for specific diagnosis.

Certain risk factors, such as extended time spent in the ICU or a central venous catheter placed in a large vein, increase an individual’s risk for infection, Chiller said. Generally, C. auris infections occur only following hospitalization for some other reason.

Chiller suggests healthcare personnel exercise good sanitation and prevention techniques to minimize spread of the infection, such as regular hand washing. Andrea Alvarez, Sentara Martha Jefferson Hospital infection preventionist, echoed the importance of having precautionary practices in place.

“If [Sentara Martha Jefferson Hospital] were to have a patient with suspected or confirmed C. auris infection, we would use contact and standard precautions to care for the patient,” Alvarez said in an email to The Cavalier Daily. “This means that healthcare providers would wear a gown and gloves when entering the patient’s room to make sure that they do not contaminate their clothing or hands with microorganisms from the patient or the patient’s room.”

Symptoms commonly associated with invasive candidiasis include fever and chills that do not respond to antibiotics, Chiller said. Most C. auris infections can be treated using antifungal drugs, but some patients exhibit strains resistant to these medications.

According to the CDC website, treatment with multiple classes of these medications simultaneously and at relatively high doses sometimes proves successful.

Beyond C. auris, the class of multidrug-resistant pathogens encountered in hospital and acute health environments includes many other organisms as well.

“Every day, healthcare providers treat patients with different types of suspected or confirmed illnesses,” Alvarez said. “Clinicians and pharmacists work together to determine what antibiotics are available and appropriate to treat the patient’s infection. The prevention and control of multidrug-resistant organisms is truly a team approach.”