New research on a frightening new superbug confirms what scientists have both suspected and feared: Some hospitalized patients who carry the fungus shed large amounts of it from their skin, contaminating the environment in which they are being treated and leaving enough of it to infect others later on.

The bug, called Candida auris, is highly resistant to many existing antifungal drugs. It’s also resistant to regular cleaning methods, making hospital outbreaks incredibly difficult to stop.

C. auris acts more like bacteria than fungi, which do not normally cause hospital outbreaks. Its relatively recent emergence as a hospital-acquired infection has researchers scrambling to find out even the most basic information about it, like how it moves from patient to patient.

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The new work was conducted by scientists from the Centers for Disease Control and Prevention in conjunction with colleagues from the Chicago Department of Public Health. It was presented Sunday at the annual conference of the American Society for Microbiology in San Francisco.

“As we’re struggling to control this organism, the reality is we don’t know how it’s spreading from person to person. We know that it does. But mechanistically we don’t know how. And so what this study was about was trying to identify the mechanism of how it can get from one person to the other,” said Joseph Sexton, a scientist with the CDC and the lead author of the work. “If we don’t understand how it spreads, we’re not going to be able to intervene.”

Before members of the team could conduct the study, they had to figure out a way to quantify how much of the fungus was present in any one place — a basic step in studying many pathogens, but not easy to do with C. auris, said Johanna Rhodes, an epidemiologist at Imperial College London. Rhodes, who studies C. auris, was not involved in the CDC research.

“A lot of us have been scratching our heads as to how the heck do you do this?” Rhodes said of the task of trying to devise a way to quantify amounts of the fungus. “It doesn’t have the standard set of genes that you would expect to find. It’s just such a weird bug.”

She was excited to learn of the CDC’s work — both the development of the quantification methods and the findings of the study on transmission of C. auris. Lots of people studying the fungus have assumed what the CDC team found, but it’s critical to actually have data, she said.

“We’ve all kind of said, ‘Yeah, we think this is it. We think this is what happens.’ [But] they’ve done the work,” said Rhodes. “It’s fundamental in our understanding of how this is actually spreading.”

The superbugs are growing in strength and it’s our fault. Hyacinth Empinado/STAT

The CDC and Chicago scientists studied 28 patients in an outbreak in what is called a ventilator-capable skilled nursing facility in Chicago. Facilities like these offer long-term care to very sick patients who are typically on ventilators, machines that breath for them. These are patients who are bed-bound.

The facility first discovered a patient carrying C. auris in March 2017. But by the time the study was done, 71% of the patients on the floor where ventilated patients are cared for were colonized with C. auris — meaning they carried it on their skin.

C. auris is an infection that is associated with patients with complex medical problems and compromised immune systems; it is generally not considered a risk to the average healthy person. But it can significantly complicate the care of people who are in intensive care units or other areas of hospitals that involve advanced care. About a third of patients who have tested positive for C. auris die, though it’s sometimes unclear if the infection was the cause of death.

The CDC-led team took skin swabs from 28 patients in the Chicago facility, swabbing their armpits and groins, which are among the places bugs that live on human bodies are often found.

They also tested a variety of surfaces in patient rooms — bed railings, doorknobs, and windowsills.

Their hypothesis was that if patient shedding was responsible for spread, they would find more of the fungus in the rooms of patients who had more of it on their skin. And indeed, they found the rooms inhabited by patients with lots of C. auris on their skin were the most contaminated with the fungus.

All of the railings on beds housing patients with C. auris tested positive for the fungus. Even the railings of two beds that contained patients who didn’t have C. auris were contaminated. Sexton said study of the patient flow on the ward revealed the beds had previously been inhabited by patients who were C. auris-positive. “So we know that they’re not doing a good enough job disinfecting the bed,” he said.

Surprisingly, three-quarters of the windowsills were also contaminated with the fungus. That was unexpected — until the team realized that windowsills were used as de facto shelves in these rooms.

“If there is a takeaway it could be …. ‘Hey, we really need to pay attention to the bed and these other areas that the patient is in contact with,’” said Sexton.

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  • My first job out of high school prior to college was as a cleaning person at the hospital. Training was 15 hours over 3 days. Then 1 week teamed with an experienced cleaner. Our work was audited multiple random times a week. The hospital was the top in Canada for many years. The workers were well paid and we worked very diligently. Many days I fell asleep on the bus home! This was in 1968. Today cleaning staff are contracted out, poorly paid and barely trained. The problem is with the system and false economies. A life is surely worth more.

  • Why bugs get spread so easily in hospitals is through an area that is too often overlooked, and not taking that department (underpaid, understaffed, under-educated, un-trained, un-supervised) is simplistic, stupid, cheap and outright dangerous. When I was hospitalized for pulmonary embolisms, a nurse tried to give the lady in the bed next to me an enema (constipation after her surgery). The patient screamed in pain, the nurse persisted, the patient climbed out of her bed, and went on all-fours to the bathroom in our shared hospital room, dragging you-know-what behind her. It was 2 am. The patient moaned in the bathroom, the nurse left. Pushing the help button brought no-one, so gasping for air I wobbled to the nursing station, asked them for help with the patient, and cleanup. NO-ONE came, and NOTHING got cleaned up. An hour later some newspaper was thrown on the poop-path. At about 10 am (after breakfast, bathroom visits etc !!!) a “cleaning lady” showed up. She dipped and squeezed the floor mop in the bucket in the hallway only ONCE, and “cleaned” the floors: first the bathroom and on her way back to the hallway the shared hospital room. In other words : she dragged excrement all through the room !! She then took a cloth, dipped it ONCE in another bucket in the hallway, and “cleaned” the surfaces : first the toilet rim and seat (!), then the sink, then its counter, then the windowsill, then some shelves. When she approached my night-table and bed with the same cloth I sent her off in no uncertain terms. THIS IS HOW BUGS SPREAD !!!!!! It was utterly disgusting and 100% un-fit for a hospital, I was aghast. I called my friend (a doctor) and was discharged with his assistance. While I was wheeled out of the ward (my friend and I masked), I saw that ALL the rooms except mine (luckily at the far end of the hallway) had a sign on them : quarantine. Leaving the superbug-infested hospital ward saved my life. Many others (it was Methacillin Resistant Staphylococcus Aureus !!) were not that lucky.
    I did not know this until a few weeks later when I had a meeting with the Hospital Administrator, explaining the “cleaning procedure”. Even with an MRSA infection brewing, cleaning methods had not been stepped up, and cleaning personnel had not been re-instructed / was not supervised etc. Some people in charge of disinfection (including the head of that division) got fired, but for some of the patients on that ward, it was too late – they died.
    There is by far not enough attention and sufficient pay to ensure hospital-appropriate cleaning and disinfecting procedures – and adherence to them. No wonder MRSA, and now (isn’t it a bit very late to finally investigate this?) Candida Auris. What’s next, if this area gets far too little attention ???

  • My husband has some little bites that are brick red and some bigger bites that have alittle pusspockee, also on his over body it looks like he has grayest color on his skin like the stuff you put on burns but we haven’t put anything on him yet & he has more on his chest, neck and shoulders small amount on back his arms and his right wrist very painful and it is swollen and in a lot of pain when having to use it looks to me that its a pretty good bit of bites on that right arm and mostly wrist. My head & neck inches of and we have been working on a houes that was buitl in 1927 the have to take out & and he took out all the old insulation old plumbing termite reinfesemest lumber this old house fixing it up butt taken out any old furnishings all old stuff and putting new in. He is in a lot of pain. Now he is havi duel & aches its is very painful. Please let us

  • What about using tea tree oil on surfaces to fight this fungus or grapefruit extract..both work well to inhibit yeast. Perhaps the patients could be given grapefruit extract also. Best Wishes!

  • I believe that a majority of your most serious, avid readers, researchers, and patients and their families would appreciate your inclusion of topic/source citations/links.

  • Excellent article. There needs to be a technology that conforms to existing protocols but does a better job. Changing the way people are currently performing a certain task is very difficult.

  • For a current, in-depth look at this topic see Matt McCarthy’s “Superbugs”.
    Dr. McCarthy provides the reader with a historical perspective and numerous future insights on this important topic.

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