Three patients with Candida auris resistant to all three classes of antifungals commonly prescribed for the illness have been identified through active and ongoing surveillance in New York, according to findings published in MMWR.
“Candida auris is a globally emerging yeast that causes outbreaks in health care settings and is often resistant to one or more classes of antifungal medications,” Belinda Ostrowsky, MD, of the Division of Healthcare Quality Promotion at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, and colleagues wrote. “Cases of C. auris with resistance to all three classes of commonly prescribed antifungal drugs (pan-resistance) have been reported in multiple countries.”
A total of 801 patients with C. auris were identified in New York between July 2016 and June 2019 based on clinical cultures obtained to identify asymptomatic colonization. Testing of the first available isolates, which was conducted between August 2016 and June 2019, revealed that 276 of 277 (99.6%) were resistant to fluconazole, 170 of 277 (61.3%) were resistant to amphotericin B and none were resistant to echinocandins. Isolates obtained later from infected patients with susceptibilities demonstrated that 330 of 331 (99.7%) were resistant to fluconazole, 210 of 331 (63.4%) were resistant to amphotericin B and 13 of 331 (3.9%) were resistant to echinocandins. Three of these patients were found to have pan-resistant C. auris that reportedly developed after receiving antifungal medications, including echinocandins.
The potential risk for resistance to treatment means that patients receiving antifungal treatment for C. auris should be watched carefully for clinical improvement and that follow-up cultures and repeat susceptibility testing should be performed, particularly in patients who received prior treatment with echinocandins.
“These findings illustrate the need to continue surveillance for C. auris, encourage prudence in the use of antifungal medications and conduct susceptibility testing on all clinical isolates, including serial isolates from a single patient, especially those treated with echinocandins,” the authors concluded. – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.