Potentially fatal Candida auris has been reported in the United States for the first time.
Thirteen cases of infection by the emerging and often multidrug-resistant fungus have been identified here so far, the CDC announced today.
Thomas R. Frieden
“We need to act now to better understand, contain and stop the spread of this drug-resistant fungus,” CDC Director Thomas R. Frieden, MD, MPH, said in a news release. “This is an emerging threat, and we need to protect vulnerable patients and others.”
First isolated from a Japanese patient’s ear canal in 2009, C. auris can cause invasive infections and is associated with a high mortality rate. It has been reported in countries in Asia, South America and Africa and in the United Kingdom, leading the CDC to issue a clinical alert in June to report C. auris and other Candida isolates that were not identified beyond species.
The first seven known C. auris infections in the U.S. occurred between May 2013 and August 2016 in four states — Illinois, Maryland, New Jersey and New York — and are described in an MMWR report. Most were isolated from blood. Five occurred in 2016, one in 2015 and one in 2013. The other six cases have been identified since August and are still being investigated, the CDC said.
Of the first seven cases, 71% showed some drug resistance, but none were resistant to all three classes of antifungals, as has been the case with some C. auris samples from other countries. Most of the cases were misdiagnosed at first, as C. auris is often misidentified as another Candida infection.
Although the U.S. cases were related to strains from South Asia and South America, none of the patients had traveled or had direct links to these areas, suggesting local infection, according to the report.
Four of the patients died. However, all seven had serious underlying medical conditions and it was unclear whether the deaths were related to C. auris infection or those other conditions, the CDC said.
Two patients treated in the same hospital or long-term–care facility had identical fungal strains, suggesting that C. auris could spread in health care facilities, the CDC said. The seven patients in the MMWR report were hospitalized for an average of 18 days.
“It appears that C. auris arrived in the United States only in the past few years,” Tom Chiller, MD, MPH, chief of the CDC’s Mycotic Diseases Branch, said in the release. “We’re working hard with partners to better understand this fungus and how it spreads so we can improve infection control recommendations and help protect people.”
To control the spread of C. auris, the CDC recommends following standard and contact precautions, cleaning the rooms of C. auris patients daily and after discharge with an EPA-registered disinfectant active against fungi, and reporting any cases to the CDC as well as state and local health departments. – by Gerard Gallagher
Vallabhaneni S, et al. MMWR Morb Mortal Wkly Rep. 2016;doi:10.15585/mmwr.mm6544e1.