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Deadly Fungus Becomes New Menace in U.S. Hospitals

Candida auris worries CDC

A potentially lethal fungus known as Candida auris has been identified in at least 61 people in the United States––mostly in New York (39 cases), New Jersey (15 cases), and Illinois (four cases)––as of April 13, 2017, according to statistics from the Centers for Disease Control and Prevention (CDC). In an interview with STAT, Dr. Anne Schuchat, acting director of the CDC, said the fungus poses a “catastrophic threat” to the public.

Schuchat said that health officials “have to do better with infection control” when it comes to containing “superbugs” of all kinds.

“This is a big threat and a wake-up call,” she said. “It was a problem for Ebola. It was a problem for SARS. It’s a problem for drug resistance.”

Some strains of C. auris are resistant to all three major classes of antifungal drugs, according to the CDC. This type of multidrug resistance has not been seen before in other species of Candida. Also of concern, C. auris can persist on surfaces in health care environments and spread between patients in health care facilities, unlike most other Candida species. C. auris is also difficult to identify with standard laboratory methods and can be misidentified in laboratories without specific technology.

Identified eight years ago in Japan, C. auris has spread around the world, the STAT article notes. It can infect wounds, infiltrate the bloodstream, and grow in the urinary tract. Patients who have undergone recent surgery, used central venous catheters, or been hospitalized for lengthy periods, as well as those with diabetes, are particularly at risk. The fatality rate is approximately 60%.

Drug-resistant “superbugs” had also worried Schuchat’s predecessor, Dr. Tom Frieden, who dubbed carbapenem-resistant Enterobacteriaceae (CRE) as “nightmare bacteria” because of their stubborn resistance to most antibiotics.

Health care facilities that suspect they have a patient with C. auris infection should contact state or local public health authorities and the CDC, the agency says.

Based on the limited data available to date, an echinocandin drug at a dose listed below is the recommended initial therapy for patients with C. auris infections.

  • Anidulafungin: loading dose 200 mg; then 100 mg daily
  • Caspofungin: loading dose 70 mg; then 50 mg daily
  • Micafungin: 100 mg daily

Although echinocandin-resistant C. auris isolates have been reported, most strains found in the United States have been susceptible to echinocandins, according to the CDC. Because this organism appears to develop resistance quickly, patients on antifungal treatment should be carefully monitored with follow-up cultures. Both recurrent and persistent C. auris bloodstream infections have been documented.

Sources: STAT; April 21, 2017; CDC; April 13, 2017; and CDC Recommendations; March 16, 2017.

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