candida auris – an emerging multidrug-resistant yeast
The CDC has received reports from international healthcare facilities that Candida auris, an emerging multidrug-resistant (MDR) yeast, is causing invasive healthcare-associated infections with high mortality. Some strains of C. auris have elevated minimum inhibitory concentrations (MICs) to the three major classes of antifungals, severely limiting treatment options. C. auris requires specialized methods for identification and could be misidentified as another yeast when relying on traditional biochemical methods. The CDC is aware of one isolate of C. auris that was detected in the United States in 2013 as part of ongoing surveillance.
Because of these reports the U.S. Centers for Disease Control and Prevention (CDC) has issued a Clinical Alert to U.S. Healthcare Facilities about the global emergence of invasive infections caused by multidrug-resistant yeast Candida auris. Experience outside the United States suggests that C. auris has high potential to cause outbreaks in healthcare facilities. Given the occurrence of C. auris in nine countries on four continents since 2009, the CDC is alerting U.S. healthcare facilities to be on the lookout for C. auris in patients.
BACKGROUND:
Candida auris is an emerging multidrug-resistant (MDR) yeast that can cause invasive infections and is associated with high mortality. It was first described in 2009 after being isolated from external ear discharge of a patient in Japan. Since the 2009 report, C. auris infections, specifically fungemia, have been reported from South Korea, India, South Africa, and Kuwait. Although published reports are not available, C. auris has also been identified in Colombia, Venezuela, Pakistan, and the United Kingdom.
It is unknown why C. auris has recently emerged in so many different locations. C. auris infections have most commonly been hospital-acquired and occurred several weeks into a patient’s hospital stay. C. auris has been reported to cause bloodstream infections, wound infections, and otitis. It has also been cultured from urine and the respiratory tract; however, whether isolation from these sites represented infection verses colonization in each instance is unknown. C. auris has been documented to cause infections in patients of all ages. At least two countries have described healthcare outbreaks of C. auris infection and colonization involving more than 30 patients each. See the Clinical Alert for more details about C. auris.
INTERIM RECOMMENDATIONS:
The CDC is concerned that C. auris will emerge in new locations, including the United States. The CDC and partners continue to work closely, and new information will be provided as it becomes available. CDC recommends the following actions for U.S. healthcare facilities and laboratories:
- Reporting – Healthcare facilities who suspect they have a patient with auris infection should contact state/local public health authorities and CDC (candidaauris@cdc.gov).
- Laboratory Diagnosis – Diagnostic devices based on matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) can differentiateauris, but not all devices currently include C. auris in the reference database to allow for detection. Molecular methods based on sequencing the D1-D2 region of the 28s rDNA can also identify C. auris. CDC requests that laboratories identifying C. auris isolates in the United States notify their state or local health departments and CDC (candidaauris@cdc.gov). C. haemulonii isolates and other isolates from clinical specimens that cannot be identified beyond Candida spp. by conventional methods can be forwarded through state public health laboratories to CDC for further characterization.
- Infection Control – Until further information is available, healthcare facilities should place patients with auriscolonization or infection in single rooms and healthcare personnel should use Standard Precautions and Contact Precautions. In addition, state or local health authorities and the CDC should be consulted about the need for additional interventions to prevent transmission. The CDC is working with domestic and international partners to develop definitive infection control guidance.
- Environmental Cleaning – Anecdotal reports have suggested that auris may persist in the environment. Healthcare facilities who have patients with C. 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.
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