Cases of Candida auris, an emerging pathogenic fungus that spreads easily in health care facilities and is often multidrug resistant, are on the rise across the United States. By the end of 2021, 3,270 infections and 7,413 instances of colonization had been reported. C. auris can cause severe and often deadly infections in high-risk individuals.
The fungus has been identified in 27 states, with the greatest number of cases in California, Florida, Illinois, Nevada, New York, and Texas. Most cases have occurred in high-acuity long-term care facilities, but there have also been outbreaks in acute care hospitals.
Cases in the United States were first reported in 2016; isolates of the fungus indicate it most likely came from South America and South Asia. Since then, C. auris has spread at increasingly alarming rates. In the April Annals of Internal Medicine, researchers examined year-over-year increases in U.S. C. auris infection and colonization since 2019. The number of reported infections increased by 44% in 2019, 59% in 2020, and a striking 95% in 2021. The number of people who were colonized (but not infected) with the fungus tripled from 2020 to 2021. As with other emerging infections, these numbers are thought to be underestimates because screening and reporting are not uniform across the country.
Resistance to echinocandin antifungals including micafungin-a first-line drug for invasive Candida infections-remains less than 5% but is increasing. In 2021, seven U.S. C. auris infections were resistant to all classes of antifungals.
C. auris is not a risk to healthy people. It poses a threat to those in the known risk groups for emerging infections: individuals who have comorbidities, are immunosuppressed, have indwelling devices, or reside for prolonged periods in health care facilities. C. auris heavily contaminates the immediate environment of infected and colonized patients, thereby increasing the reservoir of fungus available to infect others.
The Annals researchers point out that many facilities are unable to rapidly identify the fungus and implement contact precautions and other infection control measures, and this contributes to its spread. During the worst of the COVID-19 pandemic, when personal protective equipment was in short supply, the reuse of gowns and gloves by health care workers likely also fostered the spread of C. auris and other organisms.-Betsy Todd, MPH, RN