Superbug”..moving from bacteria to fungus

Dr KK Aggarwal

The fungus, Candida auris is an emerging “superbug” and is fast becoming a global health threat.

The CDC has added drug-resistant C. auris to a list of germs, which are considered as “urgent threats.”

C. auris has been reported from South Korea, India, Pakistan, Kuwait, Israel, Oman, South Africa, Colombia, Venezuela, the United States, Canada, and Europe, including the United Kingdom, Norway, Germany and Spain (Clin Microbiol Rev. 2017;31(1). pii: e00029-17). A total of 617 cases have been reported in the US till March 29, 2019.

Last year, an elderly man died due to C. auris infection after an abdominal surgery in Mount Sinai Hospital in New York City. The New York Times reported, “The man at Mount Sinai died after 90 days in the hospital, but C. auris did not. Tests showed it was everywhere in his room, so invasive that the hospital needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it … Everything was positive — the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” said Dr. Scott Lorin, the hospital’s president. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.” (New York Times, April 6, 2019)

C. auris is a deadly infection; immunocompromised persons are more vulnerable to develop this infection. People who recently had surgery, live in nursing homes, or who have breathing tubes, feeding tubes or central venous catheters are especially at higher risk.

Patients can remain colonized with C. auris for a long time and the fungus can survive on hospital surface for long duration. This facilitates spread of C. auris between patients in healthcare facilities.

C. auris can cause different types of infections, including bloodstream infection, wound infection, and ear infection. The symptoms of C. auris infection are not easily identifiable as the patients are already critically ill.

According to the CDC, infection with C. auris is of concern because:

• It is often multidrug-resistant.

• It is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology, which can lead to inappropriate management.

• 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