Candida Auris: Why is it a Secret?

Cases of resistant infections are increasing; they are called superbugs. According to the Centers for Disease Control and Prevention (CDC), there are 2 million cases of resistant infections annually in the U.S. and 23,000 fatalities as a result. Unfortunately, many healthcare facilities, patients, and providers are not eager to talk about it. Facilities are concerned about their reputations, and people are embarrassed about being contagious.

What is the latest superbug? It is a fungus called Candida auris (C. auris) and was first discovered (documented) in Japan in 2009. Why is the CDC concerned and alerting healthcare facilities in the U.S. to be on the watch for C. auris?

1. This organism is resistant to typical antifungal drugs that treat other Candida infections
2. It is causing outbreaks worldwide, including in the U.S., specifically New York, New Jersey and Illinois for a total of 587 cases
3. Specialized laboratory measures are needed because standard laboratory methods are not effective in identifying this superbug
4. Symptoms of a C. auris infection are vague – fever, aches, fatigue – and can easily go undiagnosed. People can also be carriers and not be symptomatic
5. Nearly half of patients who contract C. auris die within 90 days (Typically these patients have other serious illnesses….https://www.cdc.gov/fungal/candida-auris/candida-auris-qanda.html)

Although healthy people tend to escape this infection, the following populations are at risk: patients who frequent hospitals, those people living in nursing homes, surgical patients, diabetics, neonates, and people with weakened immune systems.

C. auris grows like a yeast and has very likely evolved from the overuse of antibiotics and antifungals. Antibiotics are widely used in farm animals raised for our meat. We spray massive amounts of antifungals on agricultural plants utilized by consumers. We also overuse antibiotics for health purposes. Even when most colds and other infections are viral in origin, we all too often demand antibiotics from our doctors (Antibiotics fight bacterial infections, not viral infections). As a result, in addition to drug-resistant bacteria, we have developed drug-resistant fungi and they are causing serious illnesses (https://draxe.com/candida-auris/).

How has C. auris evolved? When antibiotics are overused to kill unwanted bacteria, the bacteria that typically kill off the fungi are also destroyed. This results in an increase in fungi population with the potential to develop a stronger organism. When organisms like fungi are continuously exposed to antifungals, some of the fungi do not die, but simply evolve much stronger – becoming more resistant to the drugs that are supposed to kill them, such as fluconazole, amphotericin B and echinocandins. Unlike the yeast or fungal infections that we are familiar with growing on our skin, C. auris goes into the bloodstream and spreads throughout the body. As a result it can cause serious or deadly infections.

C. auris can live on inanimate objects such as bedrails, chairs, hospital equipment, and catheters that go inside the body, such as IV tubing. This organism is also spread from the hands of patients, family, and healthcare providers
(https://www.nytimes.com/2019/04/06/health/drug-resistant-candida-auris.html). To complicate conditions, these germs are found on ferried meat and manure-fertilized vegetables, on various import and export items, as well as people traveling.

How do we prevent and control infections from C. auris? Unfortunately, facilities are sometimes concerned about their reputations and staff has either “played down” the outbreaks or they try to keep it confidential. The CDC has made the following recommendations:

1. Infected patients need to be placed in private rooms with contact precautions.
2. Adherence to good hand hygiene is critical.
3. If a patient is transferred to another facility or to home, the staff must provide good communication and instructions about preventing the transfer of infection.
4. Surveillance includes appropriate testing and treatment for those infected with C. auris, but it should also include screening of others who have been exposed to infected patients or those people who have traveled to areas of reported cases.
5. In hospitals and nursing homes special cleaning equipment is often required for patient rooms because the typical cleaning agents do not necessarily kill C. auris. Again, C. Auris can be found on inanimate objects such as blood pressure cuffs, thermometers, nursing carts, and various medical apparatus, so this equipment has to be disinfected as well. There have been cases where flooring and ceiling tiles had to be removed.
6. “CDC also is working with state and local health agencies, healthcare facilities, and clinical microbiology laboratories to ensure that laboratories are using proper methods to detect C. auris and know the limitations of certain tests for detecting C. auris”  (https://www.cdc.gov/fungal/candida-auris/candida-auris-qanda.html).

Although the subject can be scary, it is not something that we want to keep secret or avoid investigating.

Charlotte Michos is a Clinical Nurse Specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions.