Candida Auris Is the "Superbug" Version of a Yeast Infection, and It’s on the Rise
The Centers for Disease Control and Prevention says the deadly fungus Candida auris is spreading at an alarming rate in the U.S.
Candida auris cases have skyrocketed in this country since 2019.
Some strains are now resistant to common treatments.
In 2017, the Centers for Disease Control and Prevention named Candida auris a “global emerging threat.” Now, the CDC says in a new report that the dangerous fungal infection is “considered an urgent antimicrobial resistance threat” and spreading “at an alarming rate” across the country.
The report, which was published in the Annals of Internal Medicine, analyzed data on Candida auris cases from across the country through Dec. 31, 2021. The researchers found 3,270 clinical cases and 7,413 screening cases of C auris, noting that there was a 44% year-over-year increase in cases in 2019, and a 95% increase in cases in 2021. From 2019 to 2021, 17 states identified their first C auris case, the report states.
Even more scary: A growing number of those cases were resistant to echinocandins, a class of antifungal drugs usually used to treat C auris. In fact, in 2021, the number of the number of C auris cases that were resistant to echinocandins was about three times that in each of the previous two years.
The researchers noted in the paper that the rise in drug-resistant cases is “particularly concerning because echinocandins are first-line therapy for invasive Candida infections, including C auris.”
The CDC notes that is an urgent antimicrobial resistance threat “because it is often resistant to multiple antifungal drugs, spreads easily in healthcare facilities, and can cause severe infections with high death rates.”
It’s understandable to have questions about Candida auris after reading all that. Here’s what you need to know about this mysterious infection—and why it should at least be on your radar.
What is Candida auris, exactly?
Again, Candida auris (aka C. auris) is a fungal infection. “The average person calls Candida infections yeast infections,” says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. However, Candida auris infections are much more serious than your standard yeast infection. “They’re a variety of so-called super bugs,” Dr. Schaffner says. “Candida auris infections can complicate the therapy of very sick people.”
It's also a hearty fungus and can be difficult for medical facilities to get rid of once it takes hold, Dr. Schaffner says.
How is Candida auris transmitted?
Most Candida auris infections are happening among people who are already sick, like cancer patients, those in ICUs, and elderly people in nursing homes, says infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security. “This isn’t an infection that strikes people out of the blue,” he says.
However, plenty of people have the infection colonized on their skin and it’s started jumping from person to person, which is why the infectious disease community is so concerned.
In general, Candida auris is “primarily transmitted from objects and equipment in the healthcare environment,” Dr. Adalja says. The CDC notes that people who have been hospitalized in a healthcare facility for a long time, have a central venous catheter, or other lines or tubes entering their body, or who have previously received antibiotics or antifungal medications, seem to be the highest risk for a C. auris infection.
Because of this, the CDC recommends that healthcare workers, patients, and families follow infection control practices, like good hand hygiene and room cleaning, to protect people who are vulnerable.
Where has Candida auris been detected in the U.S.?
The CDC is tracking Candida auris cases across the country and notes that there were 2,377 clinical cases and 5,754 screening cases from January 2022 through December 2022 (the most recent month that data is available from).
It’s been spotted in half of the country so far, with the biggest number of cases in the following states:
California
Nevada
New York
Florida
Illinois
Texas
Why is Candida auris so concerning?
Candida auris is often hard to spot and identify, according to the CDC. It’s also sparked outbreaks in healthcare settings, like hospitals and nursing homes.
But one of the biggest concerns about Candida auris is that it’s often resistant to several drugs that are commonly used to treat Candida infections, says Richard Watkins, M.D., an infectious disease physician in Akron, Ohio, and an associate professor of internal medicine at Northeast Ohio Medical University. "This has lead to a higher mortality compared to other fungal infections," he says.
What are the symptoms of Candida auris?
This is where things get a little tricky. The most common symptoms are a fever and chills that don't get better with antibiotic treatment, the CDC says. But, given that people who develop the infection usually have another underlying illness, it can be tough to spot Candida auris from symptoms alone.
Once it takes hold, the fungal infection can get into a person’s bloodstream or wounds and cause serious health issues like sepsis. “A patient’s temperature may go up, their blood pressure can go down, and they have complications of a preexisting illness because of Candida auris,” Dr. Schaffner says. The fungal infection has a high mortality rate (more than one in three patients with invasive Candida auris die, according to CDC data), but it’s tricky for doctors to say whether a person died from the fungal infection or their underlying illness. “Whatever the cause, having Candida auris doesn’t help a patient in any way,” Dr. Schaffner says.
Can Candida auris be cured?
Candida auris can be treated. “It can usually be treated with antifungal agents, but resistance to the mainstay treatment is increasing,” Dr. Adalja says.
But some C. auris infections are resistant to all three main classes of antifungal medications available in the U.S., making them difficult to treat, the CDC says. When that happens, a patient may need several antifungal medications at high doses to treat the infection.
There are new antifungals medications in development pipeline that can work against C.auris, but they’re not ready at the moment, Dr. Adalja points out.
Still, "echinocandins are still effective against most of these strains," says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York.
How can you prevent Candida auris?
In general, it comes down to “meticulous infection control,” Dr. Adalja says. That means that hospital and nursing home rooms need to be well cleaned and that people interacting with patients need to practice good hand hygiene, which will kill the infection. “There’s no other way to prevent it,” Dr. Adalja says.
People who have been hospitalized for a long time, have a central IV or other lines or tubes entering their body, or have previously been given antibiotics or antifungal medications seem to be at the highest risk of contracting the infection, which is why Dr. Schaffner recommends having a conversation with doctors to make sure that, if antibiotics are being used, they’re necessary. “Excess use of antibiotics are providing an environment in which Candida auris can occur,” he says.
In general, the average healthy person doesn’t need to stress about Candida auris, Dr. Adalja says. But if you or a loved one are hospitalized for a long time, it’s definitely something you need to be aware of.
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