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PEORIA – Illinois currently has the second highest number of confirmed cases of spreading a new superbug throughout the United States.
Candida auris, a new strain of yeast, can cause serious infections and is resistant to antifungal medications and many methods of disinfection. According to the Centers for Disease Control and Prevention, patients most at risk are those who have been hospitalized for a long time, whose body is equipped with a central venous catheter or other conduits or tubes, or who have already received antibiotics. or antifungal medications.
Between May 24, 2016 and April 4, 2019, 154 confirmed clinical cases and four probable clinical cases were identified in Illinois, according to the state's Department of Public Health. Most have been reported in the Chicago area. According to representatives of the Peoria City / County Health Department and the Tazewell County Health Department, no cases have been reported in Peoria or Tazewell counties.
A total of 587 cases and 30 probable cases were reported in the United States as of February 28, according to the CDC. New York notified 309 and New Jersey, 104 cases.
Although health care providers have been monitoring C. auris since the CDC issued the first clinical warning in 2016, most people in the general public have not heard about it before a recent wave of publicity. A New York Times article on the proliferation of superbugs underlined the difficulty with which some hospitals were getting rid of C. auris after contamination of their facilities. In 2015, a London hospital was forced to close his intensive care unit for 11 days while he was trying to eradicate C. auris. A year ago, a Brooklyn hospital had to cut down ceilings and floors to eliminate the mushroom from the room of a deceased patient.
One of the problems hospitals face is that C. auris is not easy to identify with standard laboratory methods, says the CDC. It can be misidentified in laboratories without specific technology and misidentification can lead to inappropriate management.
"We are keeping a close eye on the presence of C. auris," said Lori Grooms, director of infection prevention and control at OSF HealthCare. The OSF HealthCare St. Francis Medical Center laboratory can track the fungus and hospitals throughout the OSF HealthCare system use the lab to track C. auris.
UnityPoint Health also has the technology to detect C. auris, said Jennifer Liberty, infection prevention coordinator at UnityPoint.
"We have a real-time clinical surveillance system that helps us identify infections earlier and take appropriate infection control measures to reduce the risk of transmission," she said. "In addition, we use a sporicidal disinfectant for effective daily and final cleaning against C. auris."
The names of Illinois patients who test positive for C. auris should be included in a special registry called XDRO throughout the state, which means "register of drugs that are highly resistant to drugs". Grooms said. Patients admitted to the hospital are cross-checked in the registry. If an infected person shows up at a health facility, staff can isolate it to prevent the body from spreading in the facility.
C. auris is actually the second organism to appear on the XDRO registry, created in 2013 for another formidable bacterium, a bacterium called CRE, carbapenem-resistant Enterobacteriaceae.
"C. auris will follow the same trajectory as the CRE, "said Dr. John Farrell, an infectious disease specialist, who heads the microbiology lab at Peoria College of Medicine in Illinois. "There is nothing new under the sun and it is another example of an organism that will be a pathogen in a hospital setting. It will move from coast to coast, just like CRE did a decade ago, and we will see patients with it, and some of them will die. When CRE arrived for the first time on the map, the CDC reported a death rate of 70%. It's higher than C. auris, which is about 60%. "
If there is good news about C. auris, it is that it does not make people sick. Like all yeast infections, C. auris is an opportunistic organism that proliferates when the normal balance of organisms in the patient is killed by antibiotics, said Farrell. The patients most at risk are patients who are taking strong antibiotics.
"Patients with C. auris are patients who have been exposed to a lot of gorillacillin," he said, euphemism for last-resort antibiotics such as carbapenem. "If you develop C. auris and CRE, it's because they are the only thing that can survive when you take" gorillicillin "."
The prudent use of antibiotics is essential to manage this problem, said Farrell.
"We are proactive and are trying to reduce the use of these extremely broad and extremely potent antibiotics," he said. "The protocols are in place and we try to respect them as strictly as possible, to ensure that patients do not take these potent antibiotics longer than necessary."
Grooms have explained that patients with intravenous lines, wounds, urinary catheters, tracheostomies or long-term ventilated patients are at a greater risk of contracting C. auris.
"With very sick patients or in long-term care facilities, it's worth noting this yeast – and starting to ask questions," she said. "Every time we put a line in a patient, the question has to be how long does it have to stay and what do they always need? The rapid withdrawal of lines is very important, especially for hospitalized patients. "
Good hygiene on the part of health care providers and visitors is extremely important for very sick patients, Grooms said.
"Hand hygiene is essential every time you work with a patient. Wash your hands when you walk in and out of a room and every time you work with a loved one. When you help them eat or move around in your bed, it is essential to wash your hands before and after.
Some of the precautions currently in place to deal with the inevitable occurrence of C. auris were already in place for CRE. The superbugs are a new reality for hospitals.
"Inevitably, in the arms race between doctors and resistant organizations, organizations are always one step ahead," Farrell said.
You can contact Leslie Renken at 686-3250 or [email protected]. Follow her on Twitter.com/LeslieRenken and subscribe to her on Facebook.com/leslie.renken.
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