How to Protect Yourself From the Candida Auris Fungal Infection
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Health experts are troubled by the recent increase in the U.S. of Candida auris, a potentially deadly yeast infection found to be resistant to treatment.
Invasive Candida—or yeast—bloodstream infections are in general becoming increasingly unresponsive to the most commonly used antifungal medications.
“We’re very alarmed because some strains of C. auris in other countries are resistant to all three major classes of antifungal drugs, which we’ve never seen before," says Tom Chiller, M.D., chief of the Centers for Disease Control and Prevention's mycotic diseases branch. "We're taking as proactive and aggressive an approach as possible to try to keep it in check in the United States.”
This infection, first seen in Japan in 2009, has since spread to about a dozen countries. In the U.S. it's still rare—but its numbers are increasing.
As of late April, according to the CDC, 61 cases have been reported here, the majority of them in New York and New Jersey. Around the world, some 60 percent of people who contracted C. auris have died. In the U.S., the CDC says, about 30 percent of those with C. auris have died, but it's unclear whether the deaths were the direct result of the fungal infection or an underlying health problem.
Compounding the problem is that C. auris can move from one person to another in hospitals, unlike other invasive yeast infections. That means it can cause outbreaks because it can live on contaminated objects such as bedrails, chairs, catheters, and other equipment, and on the hands of healthcare providers.
Researchers at a recent CDC conference, who had investigated an outbreak in Colombia, said they detected C. auris in hospital rooms and on the skin patients and nurses—after patients were given antifungal medications.
“C. auris acts more like a type of bacteria called a nosocomial bacteria, which sticks to surfaces, so it can spread from patient to patient or from a healthcare provider to a patient,” explains Cornelius Clancy, M.D., director of the mycology program at the University of Pittsburgh School of Medicine. “That makes it hard to get rid of, even in hospitals that have excellent infection-control methods.”
Experts are concerned that C. auris, which is difficult to diagnose and treat, will continue to proliferate. While scientists work to understand more about how it spreads and how to treat it, here are protective steps to take if someone you love is hospitalized.
Know Who Is At Risk
If you're generally healthy, there's no current cause for concern.
“We haven’t seen [C. auris] in the general community. It’s mainly a hospital-acquired infection,” says Peter Pappas, M.D., a professor of medicine in the division of infectious disease at the University of Alabama and spokesman for the Infectious Diseases Society of America.
Thus far, this infection, like other invasive yeasts, has struck only "the sickest of the sick—people who are in and out of ICUs and also have central lines or immune-system-lowering conditions such as diabetes,” Chiller says.
Others at high risk include nursing home residents who have a central line (for the administration of medications) and people in the ICU for an extended period of time, such as transplant recipients or cancer patients on intravenous antibiotics.
5 Protective Steps
If someone you love or care for is in a hospital, nursing home, or physical rehabilitation facility:
1. Wash your hands well whenever you enter his or her room—and insist healthcare providers do the same. “One of the best ways to prevent the spread of dangerous germs like C. auris in healthcare settings is simply good hand hygiene,” Chiller says.
2. Speak up if others aren't washing their hands correctly. (Healthcare providers do this less than half the time, according to the CDC.) You may need to remind nurses, doctors, and other healthcare professionals to scrub up not only when they come into the room but also after handling a patient’s open wound, blood, or bodily fluids—or even touching their skin. Anyone who is wearing medical gloves and removes them should still wash their hands.
3. Ask whether any patients in the facility have C. auris. If so, Chiller says, find out whether additional precautionary measures have been put in place. Infected patients should be in a single room, those who come in contact with them should wear gowns and gloves, and healthcare providers should use disposable patient-care equipment for them (like some blood pressure cuffs) when possible.
4. Make sure the hospital is cleaning properly. There’s no research yet available on the best disinfectant for C. auris, but the CDC recommends the use of an Environmental Protection Agency registered hospital-grade disinfectant that's effective against Clostridium difficile spores. These tend to be the strongest disinfectants currently available, Chiller says.
5. If the person is put on IV antibiotics in the ICU, ask whether it's really necessary. “Antibiotic therapy, specifically IV antibiotics, is a significant risk factor [for any invasive candida], both the number of different antibiotics and the length of therapy,” says David Denning, M.D., a professor of infectious diseases in global health at the University Hospital of South Manchester in the United Kingdom.
According to Chiller, any antibiotic use, particularly broad-spectrum antibiotics, increases the risk of C. auris because it kills healthy bacteria in the gut.
“With less competition from other organisms, it can multiply and become more likely to spread through the body,” he notes. (Find more of our coverage on antibiotic overuse here.)
Diagnosis and Treatment Challenges
People who develop C. auris are often already quite ill, so it may be difficult to distinguish its symptoms from those of other medical conditions.
The most common signs are fever and chills that don’t improve after antibiotic treatment for suspected bacterial infections, Chiller says. If you notice this, call it to the attention of a health professional on-site.
Blood tests are usually used to diagnose invasive Candida infections. When C. auris is suspected, hospital staff should use a special laboratory test called matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF).
If the test is positive for the fungal infection, the CDC recommends concurrent treatment with three antifungals: anidulafungin, caspofungin, and micafungin.
“So far in the United States, all cases have ended up responding (to the current CDC-recommended protocol),” Chiller says. But because C. auris develops resistance quickly, it’s important for anyone with this serious fungal infection to receive follow-up cultures.
There's also hope for new treatments down the line. Research published last month in the journal Antimicrobial Agents and Chemotherapy, for example, found that C. auris was at least partially responsive to an investigative drug.
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