WHILE OUR ATTENTION HAS SHIFTED TO COVID PREVENTION, OTHER PATHOGENS STILL REQUIRE INFECTION CONTROL EFFORTS

WHILE OUR ATTENTION HAS SHIFTED TO COVID PREVENTION, OTHER PATHOGENS STILL REQUIRE INFECTION CONTROL EFFORTS

While our Attention has Shifted to COVID Prevention, Other Pathogens Still Require Infection Control Efforts

Article by CDC expert Dr. Tom Chiller from August 24, 2017 discusses The Unexpected and Troubling Rise of Candida auris an emerging fungus that presents a serious global health threat.

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Centers for Disease Control and Prevention,  National Center for Emerging and Zoonotic Infectious Diseases (NCEZID),  Division of Foodborne, Waterborne, and Environmental Diseases (DFWED)

GENERAL INFORMATION ABOUT CANDIDA AURIS

  1. It is often multidrug-resistant, meaning that it is resistant to multiple anti-fungal drugs commonly used to treat Candida infections. Some strains are resistant to all three available classes of antifungals.
  2. It is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology. Misidentification may lead to inappropriate management.
  3. It has caused outbreaks in healthcare settings. For this reason, it is important to quickly identify C. auris in a hospitalized patient so that healthcare facilities can take special precautions to stop its spread.

CDC encourages all U.S. laboratory staff who identify C. auris to notify their state or local public health authorities and CDC at candidaauris@cdc.gov.

Learn more about how CDC uses whole genome sequencing to detect outbreaks of C. auris in healthcare facilities.

Healthcare facilities in several countries have reported that a type of yeast called Candida auris has been causing severe illness in hospitalized patients. In some patients, this yeast can enter the bloodstream and spread throughout the body, causing serious invasive infections. This yeast often does not respond to commonly used antifungal drugs, making infections difficult to treat. Patients who have been hospitalized in a healthcare facility a long time, have a central venous catheter, or other lines or tubes entering their body, or have previously received antibiotics or antifungal medications, appear to be at highest risk of infection with this yeast.

Specialized laboratory methods are needed to accurately identify C. auris. Conventional laboratory techniques could lead to misidentification and inappropriate management, making it difficult to control the spread of C. auris in healthcare settings.

Because of these factors, CDC is alerting U.S. healthcare facilities to be on the lookout for C. auris in their patients.

TRACKING - CANDIDA AURIS

Candida auris is an emerging fungus that presents a serious global health threat. C. auris causes severe illness in hospitalized patients in several countries, including the United States. Patients can remain colonized with C. auris for a long time and C. auris can persist on surfaces in healthcare environments. This can result in spread of C. auris between patients in healthcare facilities.

Strains of C. auris in the United States have been linked to other parts of the world. U.S. C. auris cases are a result of inadvertent introduction into the United States from a patient who recently received healthcare in a country where C. auris has been reported or a result of local spread after such an introduction.

Candida auris was made nationally notifiable at the 2018 Council for State and Territorial Epidemiologists (CSTE) Annual Conference. For the updated case definition and information on the nationally notifiable condition status, please see the 2018 CSTE position statement.

To view the NNDSS HL7 Healthcare-Associated Infections, Multidrug-Resistant Organisms (HAI MDRO) Message Mapping Guide, which includes C. auris and CP-CRE, visit MMGs and Artifacts.

LAB TECHNICIANS AND HEALTHCARE PROFESSIONALS

Candida auris is an emerging yeast that can be misidentified as other organisms, is multidrug resistant, and can spread in healthcare settings. It is important to know how to identify, treat, and control the spread of this organism.  The resources below are meant for laboratorians, clinicians, infection control practitioners, and public health professionals.

Healthcare facilities or laboratories that suspect they have a patient with C. auris infection should contact state or local public health authorities and CDC (candidaauris@cdc.gov) immediately for guidance. 

INFORMATION FOR LABORATORY STAFF AND INFECTION PREVENTIONISTS

PATIENT EDUCATION

INFORMATION FOR RESEARCHERS AND INDUSTRY PROFESSIONALS

Researchers and industry professionals can make a big impact in the fight against C. auris. Because C. auris emerged so recently, we still have a lot to learn about this yeast and we need the greater medical and research community involved to figure out the best ways to stop transmission and care for patients with C. auris. The resources below are meant for researchers and industry professionals looking to advance our understanding of C. auris or expand the resources available for combating this yeast.

There is great need for the following items to combat C. auris:

  • Rapid diagnostics

  • New drugs

  • Decolonization methods

  • Registered, easy-to-use, and effective disinfectants

  • Other tools or protocols for treatment and prevention

Researchers and industry professionals at approved institutions can obtain a panel of isolates of C. auris and other yeasts from the CDC and FDA AR Isolate Bank. Isolates are free; recipients just pay for shipping.

The C. auris panel contains 11 C. auris isolates, representing the 4 main clades. Clades and susceptibility testing results are located on AR Isolate Bank webpages. Additionally, the panel contains 10 isolates from 6 related yeast species (such as Candida haemulonii).

Scientists should practice laboratory safety whenever working with C. auris or other pathogens. Please visit the Safety Considerations When Working with Known or Suspected Isolates of Candida auris webpage for more information.

Disinfectant testing and claims

The Environmental Protection Agency (EPA) has issued guidance external icon and methods external icon for antimicrobial efficacy testing of products against C. auris. This guidance is specifically for testing liquid antimicrobials against C. auris on hard, non-porous surfaces. To obtain a C. auris claim, a product must be tested using EPA’s methods and an application must be submitted to the EPA for review. Researchers and companies that plan to submit a claim request are encouraged to inform the EPA of that intention before submission.

Researchers and companies with disinfection products that can’t be appropriately evaluated with the MB-35-00 method external icon may consider contacting the EPA to discuss appropriate testing methods. 

CANDIDA AURIS INFORMATION FOR PATIENTS AND FAMILY MEMBERS

Candida auris (C. auris) is a type of fungus that can cause serious illness in hospitalized patients. Infections with this fungus can be difficult to treat. C. auris only recently appeared in the United States, and public health officials are researching more about how it is spread. Here’s what you need to know if you or a family member have a C. auris infection.

What are the symptoms of C. auris infection?

  • Symptoms may not be noticeable, because patients with C. auris infection are often already sick in the hospital with another serious illness or condition.
  • Symptoms of C. auris infection depend on the part of the body affected. C. auris can cause many different types of infection, such as bloodstream infection, wound infection, and ear infection.
  • Because symptoms can vary greatly, a laboratory test is needed to determine whether a patient has a C. auris infection.

Who is most likely to get C. auris infection?

  • C. auris mainly affects patients who already have many medical problems.
  • It often affects people who have had frequent hospital stays or live in nursing homes.
  • C. auris is more likely to affect patients who have weakened immune systems from conditions such as blood cancers or diabetes, receive lots of antibiotics, or have devices like tubes going into their body (for example, breathing tubes, feeding tubes, catheters in a vein, or bladder catheters).
  • Healthy people usually don’t get C. auris infections.

Are C. auris infections treatable?

  • Most C. auris infections are treatable with a class of antifungal medications called echinocandins.
  • Some C. auris infections have been resistant to all three main classes of antifungal medications, making them difficult to treat. In this situation, multiple antifungal medications at high doses may be needed to treat the infection.

How serious can C. auris infection be?

  • Any invasive infection, which includes bloodstream infection with any Candida species, can be serious and even fatal.
  • Many people who have died with C. auris had other serious illnesses that increased their risk of death.

Why does a patient with C. auris infection need special precautions during care?

  • C. auris can spread from one patient to another in healthcare settings, such as hospitals and nursing homes, even if C. auris is on the skin or other body sites and the patient does not have symptoms.
  • Special precautions reduce the chance of spreading the fungus to other patients. These precautions may include:
    • Placing the patient in a different room.
    • Having healthcare personnel or other caregivers wear gowns and gloves during patient care.
    • Cleaning the room with different products than usual.
    • Having family members and healthcare personnel clean their hands thoroughly after visiting the patient. The patient may also be encouraged to wash their hands often.

How long does a patient with C. auris need to be under these special precautions?

  • Even after C. auris infection is treated, patients might continue to have C. auris on their skin or other body sites that doesn’t cause infection or illness but can still spread to other patients.
  • Special precautions should continue as long the patient has C. auris on the skin or other body sites. In most situations, precautions should be continued for the entire duration of the patient’s stay in a healthcare facility. More about the duration of precautions can be found in CDC’s infection control guidance.

Can a nursing home patient with C. auris participate in activities with others, such as meals or social gatherings, if they are on these special precautions?

In general, residents of nursing homes who have C. auris on their skin or other body sites or are sick with a C. auris infection can leave their rooms to attend meals and group functions if:

  • They can wash their hands thoroughly on a regular basis.
  • Wounds are bandaged to prevent any fluids from seeping out and infecting others.
  • Other types of secretions like phlegm are contained.
  • Items that residents touch often and shared equipment (for example, physical therapy equipment or recreational resources) should be cleaned and disinfected after use.

Can family members get sick?

  • Family members who are healthy probably have a low chance of C. auris infection.
  • C. auris is mainly a problem among people who are already sick with multiple medical problems and have spent a lot of time in healthcare settings.
  • Family members and others caring for patients with C. auris should wash their hands thoroughly before and after touching the patient or touching medical devices.
  • Handwashing is particularly important if the caregiver is caring for more than one ill person at home.
  • Ask and remind healthcare personnel to wash their hands.

Should family members or other close contacts of patients be tested for C. auris?

  • In most instances, CDC does not recommend that family members or other close contacts of patients with C. auris infections be tested for C. auris.
  • However, if someone who has frequent contact with a patient with C. auris is admitted to a healthcare facility, a healthcare provider might test them for C. auris to determine if special precautions should be used.

What should people who have tested positive for C. auris do after being discharged from healthcare facilities?

People who have tested positive for C. auris should inform healthcare providers that they have tested positive for C. auris when visiting healthcare offices and when being admitted to hospitals and nursing homes.

CDC and state and local public health officials are concerned about C. auris infection and are working closely to track and control its spread.

ADDITIONAL RESOURCES

FACT SHEETS

INFORMATION FOR PATIENTS

INFORMATION FOR LABORATORY STAFF AND INFECTION PREVENTIONISTS

INFORMATION FOR PUBLIC HEALTH PROFESSIONAL

MORE CANDIDA AURIS RESOURCES

CLINICAL ALERTS

RECOMMENDATIONS AND GUIDELINES

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