he US Centers for Disease Control and Prevention is warning health facilities to be on the lookout for a multidrug-resistant type of yeast infection that has infected hundreds of patients across the globe. The infection has most commonly been contracted during a hospital stay of several weeks, according to a CDC alert to US clinicians.
Candida auris — a species of Candida, a common cause of fungal infections — was first identified in 2009 in the ear discharge of a hospitalized patient in Japan. It has since been seen to cause invasive infections in wounds, the bloodstream, and the urinary tract, said Tom Chiller, chief of the mycotic diseases branch of the CDC.
Based on information from a limited number of patients, C. auris infections have a mortality rate of around 60 percent, double the 30 percent death rate of patients with invasive candidemia, a Candida bloodstream infection, according to the CDC.
C. auris strains tend to be resistant to at least one or two of the antifungal drugs typically used to treat yeast infections. “A couple of the isolates are resistant to all three classes of antifungals used to treat Candida,” Chiller said.
It’s unclear why C. auris has emerged now, but Chiller said researchers suspect medication use may be a factor. As a patient repeatedly uses an antifungal drug, it creates a selection pressure for yeasts that evade the drug, leaving survivors who are very drug-resistant, he said, adding, “We need to think hard about how we use these drugs.”
The CDC is aware of only one isolate of C. auris in the US, detected in 2013, but outside the US, outbreaks of different C. auris strains have sickened more than 30 patients.
The drug-resistant yeast has been found in nine geographically dispersed countries — Japan, South Korea, India, South Africa, Kuwait, Colombia, Venezuela, Pakistan, and the United Kingdom — since 2009, although retrospective testing reveals that the earliest infection occurred in South Korea in 1996, according to the CDC alert.
The CDC’s analysis reveals that isolates within countries or regions are very similar to each other, but are distinct across countries, suggesting that the drug-resistant strains of C. auris arose independently.
The CDC is concerned that C. auris will emerge in new locations, including the US. It advises health care facilities and laboratories to report any suspected C. auris infections to state and local health authorities, and to the CDC. Any patient with a C. auris infection should be isolated, and their rooms should be cleaned and disinfected with EPA-registered hospital-grade disinfectant with a fungal claim, according to the alert.
The agency asked that health care facilities that suspect they have a patient with a C. auris infection contact state or local public health authorities as well as the CDC.
So far, these yeast infections have been limited to long-term hospitalized patients, Chiller said, so the general public doesn’t need to worry about getting infected with C. auris. But the infections are a reminder of the importance of handwashing, particularly in hospitals, he said.