FROM MORBIDITY AND MORTALITY WEEKLY REPORT

The Centers for Disease Control and Prevention have reported the first cases of the multidrug-resistant fungal infection Candida auris in the United States, with evidence suggesting transmission may have occurred within U.S. health care facilities.

The report, published in the Nov. 4 edition of Morbidity and Mortality Weekly Report, described seven cases of patients infected with C. auris, which was isolated from blood in five cases, urine in one, and the ear in one. All the patients with bloodstream infections had central venous catheters at the time of diagnosis, and four of these patients died in the weeks and months after diagnosis of the infection.

All the patients had serious underlying medical conditions such as hematologic malignancies, bone marrow transplant, short gut syndrome, paraplegia, acute respiratory failure, peripheral vascular disease, and osteomyelitis. The first case occurred in New York state in May 2013. The cases presented gradually between that year and 2016. In addition to New York, other affected patients were in Illinois, Maryland, and New Jersey.

Patients’ underlying conditions usually involved immune system suppression resulting from corticisteroid therapy, malignancty, short gut syndrome, or parapleglia with a long-term, indwelling Foley catheter.

C. auris was first isolated in 2009 in Japan, but has since been reported in countries including Colombia, India, South Africa, Israel, and the United Kingdom. Snigdha Vallabhaneni, MD , of the mycotic diseases branch of CDC’s division of food water and environmental diseases, and her coauthors, said its appearance in the United States is a cause for serious concern ( MMWR. 2016 Nov 4. doi: 0.15585/mmwr.mm6544e1 ).

“First, many isolates are multidrug resistant, with some strains having elevated minimum inhibitory concentra­tions to drugs in all three major classes of antifungal medications, a feature not found in other clinically relevant Candida species,” the authors wrote. All the patients with bloodstream infections were treated with antifungal echinocandins, and one also received lipo­somal amphotericin B.

“Second, C. auris is challenging to identify, requiring specialized methods such as matrix-assisted laser desorption/ionization time-of-flight or molecular identification based on sequencing the D1-D2 region of the 28s ribosomal DNA.”

They also highlighted that C. auris is known to cause outbreaks in health care settings. Samples taken from the mattress, bedside table, bed rail, chair, and windowsill in the room of one patient all tested positive for C. auris.

The authors also sequenced the genome of the isolates and found that isolates taken from patients admitted to the same hospital in New Jersey or the same Illinois hospital were nearly identical.

“Facilities should ensure thorough daily and terminal cleaning of rooms of patients with C. auris infections, including use of an [Environmental Protection Agency]–registered disinfectant with a fungal claim,” the authors wrote, stressing that facilities and laboratories should continue to report cases and forward suspicious unidentified Candida isolates to state or local health authorities and the CDC.

No conflicts of interest were declared.

fpnews@frontlinemedcom.com

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