CDC – First Cases of Candida auris Reported in the United States
The new issue of the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR) presents the thirteen cases of Candida auris (C. auris) that have been identified in the United States. Seven of the cases that occurred between May 2013 and August 2016 are described in the report; the six other cases, identified after the period covered by the report, are still under investigation. The report is the first to describe U.S. cases of C. auris infection. C. auris is often resistant to antifungal drugs and tends to occur in hospitalized patients
In June 2016, the CDC issued a clinical alert (see StayAlert! Notice published on June 28, 2016) describing the global emergence of C. auris and requesting that laboratories report C. auris cases and send patient samples to state and local health departments and CDC. Since then, the CDC has been investigating reports of C. auris with several state and local health departments.
Among the seven cases detailed in the report, patients with C. auris were reported in four states: New York, Illinois, Maryland and New Jersey. All of the patients had serious underlying medical conditions and had been hospitalized an average of 18 days when C. auris was identified. Four of the patients died; it is unclear whether the deaths were associated with C. auris infection or underlying health conditions. In two instances, two patients had been treated in the same hospital or long-term-care facility and had nearly identical fungal strains. These findings suggest that C. auris could be spread in healthcare settings.
Most of the C. auris strains from U.S. patients (71 percent) showed some drug resistance, making treatment more difficult. Samples of C. auris strains from other countries have been found to be resistant to all three major classes of antifungal medications. However, none of the U.S. strains in this report were resistant to all three antifungal drug classes. Based on laboratory testing, the U.S. strains were found to be related to strains from South Asia and South America. However, none of the patients travelled to or had any direct links to those regions. Most patients likely acquired the infections locally.
The CDC recommends that healthcare professionals implement strict standard contact precautions to control the spread of C. auris. Facilities should conduct thorough daily and after-discharge cleaning of rooms of C. auris patients with an EPA-registered disinfectant active against fungi. Any cases of C. auris should be reported to CDC and state and local health departments. CDC can assist in identifying this particular type of Candida if needed.
Summary of interim recommendations issued in June 2016:
- Reporting — Healthcare facilities who suspect they have a patient with C. auris infection should contact state/local public health authorities and CDC (firstname.lastname@example.org).
- Laboratory Diagnosis — CDC requests that laboratories identifying C. auris isolates in the United States notify their state or local health departments and CDC (email@example.com).
- Infection Control — Until further information is available, healthcare facilities should place patients with C. auris colonization or infection in single rooms and healthcare personnel should use Standard and Contact Precautions. In addition, state or local health authorities and CDC should be consulted about the need for additional interventions to prevent transmission. CDC is working with domestic and international partners to develop definitive infection control guidance.
- Environmental Cleaning – Anecdotal reports have suggested that C. auris may persist in the environment. Healthcare facilities who have patients withC. auris infection or colonization should ensure thorough daily and terminal cleaning and disinfection of these patient’s rooms using an EPA-registered hospital grade disinfectant with a fungal claim.
Included with today’s notice are example policies related to the above CDC interim recommendations.
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