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For the very first time, researchers have reported cases of people carrying or infected with strains of the dangerous fungus Candida auris who were resistant to all classes of antifungal drugs before any treatment, the Centers for Disease Control and Prevention said Thursday. The agency also reported evidence of some transmission of the strains within healthcare facilities.
Candida auris, or C. auris, which was first observed in 2009, has been very resistant to the few treatment options available for several years, leaving those who treat and study fungal diseases concerned about the toll this superbug takes. could do, especially patients. Of particular concern is the fact that there are now so-called pan-resistant cases in people who had never been treated with antifungal drugs, experts said.
The CDC has reported five cases, three in Washington, DC and two in Texas. In both places, cases were grouped within institutions. The facilities have not been identified, but the fungus is most often diagnosed in very ill people who are in specialized long-term care facilities.
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There was no known link between the Washington and Texas cases. The cases were described in the CDC’s online review Morbidity and Mortality Weekly Report.
Pan-resistant C. auris was first detected in 2019 in people who developed resistance while being treated with antifungal drugs. What makes these newly reported cases more concerning is the fact that none of the people had been treated with antifungal drugs prior to diagnosis. This means that the strain of C. auris they captured was already pan-resistant.
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“This is the first time that we have identified clusters with common health care exposures in the same facilities and among patients who had not received antifungals”, Meghan Lyman, doctor in the fungal diseases branch ( fungal) from the CDC National Center. for emerging infectious and zoonotic diseases, STAT said in an interview.
There are only three classes of antifungal drugs: azoles, polyenes, and echinocandins. Most cases of C. auris detected in the United States are resistant to azoles (85%) and many are resistant to polyenes (38%). The overwhelming majority (99%) were sensitive to echinocandin drugs, so they are the first line of treatment when C. auris is detected.
These pan-resistant enclosures raise questions about the length and quality of the front-line outfit.
“These cases are where the options are really limited. There are few treatment options for these patients with clinical infections. And the fact that now it can spread, it’s not just in patients who are already receiving treatment … means that a greater proportion of patients can have pan-resistance and [may] develop potentially incurable clinical infections, ”Lyman said.
During the Texas outbreak, in addition to the two pan-resistant cases, there were five patients with C. auris which was resistant to both echinocandins and fluconazole, an azole-class antifungal drug. The seven were detected in two different establishments, but there was movement of patients between the two establishments.
The 30-day death rate among patients from the Texas and Washington outbreaks was 30%, but since these people were all critically ill, it is not possible to say whether C. auris infections caused or contributed to upon their death.
In some cases, C. auris has been found on the skin of people; in epidemiological terms, they were “colonized”. In this condition, the fungus does not cause disease, but colonized people can pass the fungus to other patients and can eventually develop active infections on their own. Lyman said that between 5% and 10% of people with C. auris will later have active or “invasive” infections.
Although this report only deals with five cases, it is likely that there are more, Lyman said. The Covid-19 pandemic has siphoned off the ability to monitor other pathogens; even before the pandemic, surveillance for drug-resistant fungal infections was spotty.
“It could be under-detected. It’s very likely, ”she said.
Despite insufficient surveillance, researchers say the pandemic has fueled an increase in C. auris cases. A number of people who become seriously ill with Covid need care in the types of facilities where these fungal infections are found.
“We tend to see transmission and to see cases among the patients who are in these high acuity long-term care facilities… who have very high acuity and very sick patients like those who are on ventilators or who have a tracheostomy or other invasive medical devices, “Lyman said.” Getting Covid and then having these complications puts them at a higher risk of getting Candida auris. “
Facilities treating such patients should be on high alert for C. auris, she said, as finding it quickly is key to containing it.
“With all this spread that we’ve seen across the country, we’re really encouraging health services and facilities to be more proactive rather than reactive in identifying Candida auris in general. Because we have found that controlling the situation and containing the spread is really easier when identified early before there is widespread transmission. “
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