under the microscope
By Paul J . Pearce , PhD
Update : The NCEZID and Candida auris
The National Center for Emerging and Zoonotic Infectious
Diseases ( NCEZID ) works to protect people from emerging and zoonotic infections ranging from A to Z — anthrax to Zika . We live in an interconnected world where an outbreak of infectious disease is just a plane ride away .
Candida auris is an emerging fungal ( yeast ) pathogen that presents a serious global health threat . The Centers for Disease Control and Prevention ( CDC ) and NCEZID are concerned about C . auris for five main reasons :
➊ It is often multidrug-resistant , meaning that it is resistant to multiple antifungal drugs commonly used to treat Candida infections . Some strains are resistant to all three available classes of antifungals .
➋ It is difficult to identify with standard laboratory methods , and it can be misidentified in labs without specific technology . Misidentification may lead to inappropriate management . It has caused outbreaks in healthcare settings , so it is important to quickly identify C . auris in a hospitalized patient so that organizations can take special precautions to stop its spread .
➌ C . auris is typically acquired in healthcare settings , so most healthy people are not at risk . It is passed from person-to-person through the hands of healthcare personnel or by contaminated medical devices like catheters or ventilators . Patients with C . auris may be put under special precautions , such as being placed in an isolation room . This may continue even after treatment because they may still have C . auris on their skin or other sites on their body . Practice proper hand hygiene and use of personal protective equipment ( PPE ) such as gloves , masks , and gowns . Patients should make sure to carefully follow instructions from their doctor regarding antifungal medications .
➍ Frequently recommended and used environmental cleaners and disinfectants may not be effective in controlling or killing C . auris .
The NCEZID was established in 2010 with a mission and scientific activities that trace back to the earliest days of the CDC , including protecting against and responding to infectious disease outbreaks . NCEZID is responsible for the prevention , control , and management of a wide range of infectious diseases , including rare but deadly diseases such as anthrax and Ebola virus disease , as well as more common illnesses like foodborne disease and healthcare-associated infections . NCEZID is one of the agency ’ s principal sources of epidemiologic , clinical , and laboratory expertise for bacterial , viral , and fungal pathogens as well as infectious diseases of unknown origin . The nation relies on NCEZID to protect the country from more than 800 dangerous pathogens . C . auris falls in the category of emerging , opportunistic pathogens that is a threat to patients in healthcare settings .
Why is Candida auris a problem ?
• It causes serious infections , such as bloodstream and other types of invasive infections , particularly in patients in hospitals and nursing homes who have many medical problems . More than 1 in 3 patients die within a month of being diagnosed with an invasive C . auris infection .
• It is often multidrug-resistant . Antifungal medications commonly used to treat other Candida infections often don ’ t work for C . auris . Some C . auris isolates are resistant to all three major classes of antifungal medications .
• It is becoming more common . Although C . auris was just discovered in 2009 , the number of cases has grown quickly .
• It is difficult to identify . C . auris can be misidentified as other types of fungus unless specialized laboratory methods are used . Correctly identifying C . auris is critical for starting measures to stop its spread and prevent outbreaks .
• It can spread and cause outbreaks in healthcare facilities . Just like other multidrug-resistant organisms such as carbapenem-resistant Enterobacteriaceae ( CRE ) and methicillin-resistant Staphylococcus aureus ( MRSA ), C . auris can be transmitted in healthcare settings and cause outbreaks . It can colonize patients for many months , persist in the environment , and withstand some commonly used healthcare facility disinfectants .
What should I do if there is C . auris in my facility ?
➊ Check the CDC website for the most up-to-date guidance on identifying and managing C . auris : www . cdc . gov / fungal / candida-auris .
➋ Report possible or confirmed C . auris test results immediately to your public health department .
➌ Ensure adherence to CDC recommendations for infection control , including placing patients infected or colonized with C . auris on Transmission-Based Precautions and , whenever possible , in a single room ; making sure gown and gloves are accessible and used appropriately ; reinforcing hand hygiene as well as coordinating with environmental services ( EVS ) to monitor and ensure the patient care environment is cleaned using a disinfectant with an Environmental Protection Agency claim for C . auris or , if not available , for Clostridioides difficile . These products can be found at www . cdc . gov / fungal / candida-auris / c-auris-infection-control . html . Some disinfectants used in healthcare facilities ( e . g ., quaternary ammonium compounds [ QACs ]) may not be effective against C . auris , despite claims about effectiveness against C . albicans or other fungi . Work with the EVS team to monitor the cleaning process . Review EPA Lists N and P for disinfectants that are recognized as effective against C . auris .
➍ After consulting with public health personnel , screen contacts of case-patients to identify patients with C . auris colonization . Use the same infection control measures for patients found to be colonized .
➎ When a patient is being transferred from your facility ( to a nursing home or other hospital ), clearly communicate the patient ’ s C . auris status to receiving healthcare providers .
Paul J . Pearce , PhD , leads the Pearce Foundation for Scientific Endeavor .
References : https :// www . cdc . gov / ncezid / pdf / ncezid-strategic-plan-2018-2023-508 . pdf https :// www . epa . gov / pesticide-registration / list-p-antimicrobial-products-registeredepa-claims-against-candida-auris www . thepearcefoundation . org