A fungus resistant to antimicrobial treatments is spreading at an alarming rate in U.S. healthcare facilities, including those in Ohio and Pennsylvania according to the Centers for Disease Control.

The CDC reported on Monday that the Candida auris fungus, considered an urgent antimicrobial resistance threat, was reported to have spread in 2020 through 2021, according to published in the Annals of Internal Medicine.

In addition to 33 cases in Ohio, there were 79 cases in Ohio last year.   The Ohio Department of Health recorded 285 cases in the state between May 13, 2020 and November 18, 2022, including one in Columbiana County. 

The widest occurrence of the fungus was in the Cincinnati area with 212 cases during the 30 month period.

 

  Ohio Department of Health

 

The CDC said it is also concerned with a tripling in 2021 of the number of cases that were resistant to echinocandins, the antifungal medicine most recommended for treatment of C. auris infections.

 In general, C. auris is not a threat to healthy people.?People who are very sick, have invasive medical devices, or have long or frequent stays in healthcare facilities are at increased risk for acquiring C. auris.

CDC has deemed C. auris as an urgent AR threat, because it is often resistant to multiple antifungal drugs, spreads easily in healthcare facilities, and can cause severe infections with high death rates.

“The rapid rise and geographic spread of cases is concerning and emphasizes the need for continued surveillance, expanded lab capacity, quicker diagnostic tests, and adherence to proven infection prevention and control,” said CDC epidemiologist Dr. Meghan Lyman, lead author of the paper.

As further explained in the article, C. auris has spread in the United States since it was first reported in 2016, with a total of 3,270 clinical cases (in which infection is present) and 7,413 screening cases (in which the fungus is detected but not causing infection) reported through December 31, 2021.

Clinical cases have increased each year since 2016, with the most rapid rise occurring during 2020-2021. CDC has continued to see an increase in case counts for 2022. During 2019-2021, 17 states identified their first C. auris case ever.

Nationwide, clinical cases rose from 476 in 2019 to 1,471 in 2021. Screening cases tripled from 2020 to 2021, for a total of 4,041. Screening is important to prevent spread by identifying patients carrying the fungus so that infection prevention controls can be used

C. auris case counts have increased for many reasons, including poor general infection prevention and control (IPC) practices in healthcare facilities.

Case counts may also have increased because of enhanced efforts to detect cases, including increased colonization screening, a test to see if someone has the fungus somewhere on their body but does not have an infection or symptoms of infection.

The timing of this increase and findings from public health investigations suggest C. auris spread may have worsened due to strain on healthcare and public health systems during the COVID-19 pandemic.

The CDC says it has worked to significantly strengthen laboratory capacity, including in state, territorial, and local health departments, through supplemental funding supported by the American Rescue Plan Act. These efforts include increasing susceptibility testing capacity for C. auris from seven Regional Labs to more than 26 labs nationwide.

According to the Pennsylvania Department of Health, C. auris can spread in health care settings through contact with contaminated environmental surfaces or equipment or from person to person. Transmission is not thought to occur via persistent colonization of healthcare workers.

Laboratory diagnosis of clinical infection is made through routine cultures. However, C. auris can be misidentified as several different organisms.

The primary infection control measures for prevention of C. auris transmission in healthcare settings are as follows:

  • Adherence to hand hygiene. Alcohol-based hand rub is effective against C. auris and is the preferred method for routine hand hygiene.
  • Appropriate use of transmission-based precautions. Patients colonized or infected with C. auris in hospitals and nursing homes should be managed using contact precautions.
  • Cleaning and disinfecting the patient care environment, including thorough daily and terminal cleaning, and reusable equipment with an EPA-registered disinfectant that is effective against C. auris or a product with documented effectiveness against C. auris by CDC, is critical as C. auris can persist on surfaces in healthcare settings. If none of these products are available, an EPA-registered hospital-grade disinfectant effective against Clostridioides difficile spores can be used. The CDC notes that many products with label claims against COVID-19 are not effective against C. auris.
  • Inter-facility communication about patient’s C. auris status when a patient is transferred to another healthcare facility.
  • Screening contacts of newly identified case patients to identify C. auris colonization.
  • Laboratory surveillance of clinical specimens to detect additional cases