FEATURE
Having the laboratory capacity
to process these colonization
swabs is a huge thing. The whole
aim here is timely data to allow us
to take the appropriate infection
control and public health actions.”
Marion Kainer, MD, MPH
The Candida team from the Wadsworth Center Mycology Laboratory. First row (from l to r): Yan Chun Zhu, Brittany O’Brien, Sudha
Chaturvedi. Second row (from l to r): Mitchell Kaplan, Manuel Pazos, Jiali Liang, Rokebul Anower. Photo: Wadsworth Center
One organism so far undetected in
Tennessee, but an emerging problem
elsewhere in the US is antibiotic-resistant
Candida auris.
“When CDC put out the original [AR]
threats report in 2013, we didn’t even
mention this, because we didn’t know
about it,” said Craig. “It seems to have
emerged independently in multiple places
around the world and then spread. We
don’t know yet how or why it emerged
when it did.”
Antibiotic-resistant Candida auris is
known for its extreme hardiness in the
environment; its ability to colonize the
human gut, skin and bloodstream—and a
mortality rate as high as 80%, depending
on the strain and infection site.
The organism was first described in
a Japanese patient in 2009 and first
identified in New York state at the time
of a multi-hospital outbreak in New York
City (NYC) in 2016. According to the New
York State Department of Health, it can
now “probably be considered endemic
within some parts of the healthcare
system in Brooklyn and Queens.”
As of May 31, 2019, the Wadsworth
Center—the New York state public health
laboratory and Northeast Regional AR
Lab Network Laboratory—confirmed 334
clinical cases of drug-resistant C. auris
among NYC residents, with infection
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almost exclusively limited to people
with extensive healthcare needs, such
as nursing home residents with chronic
ventilator usage and people with multiple
ICU admissions.
To speed detection of the organism during
the outbreak, Wadsworth scientists moved
from MALDI-TOF mass spectrometry
testing—which requires culturing
specimens over 4 to 14 days—to a rapid
molecular assay developed in-house. The
new assay provides results within one day
of specimen receipt.
To date, the Wadsworth Center has
screened over 17,000 surveillance
specimens from the NYC area and
detected drug-resistant C. auris on the
skin of over 450 healthy individuals, 40 of
whom went on to develop illness and are
also included in the clinical case count.
The Center’s molecular assay has been
adopted by CDC and several other AR Lab
Network members.
“If we’re not looking for it, it’s going
to disseminate”
nurses and other stakeholders across
the healthcare system; and working with
sentinel laboratories that serve high-risk
populations, such as ventilated nursing
home patients and “medical tourists” who
have had healthcare abroad. “When you’re
doing [AR] surveillance, you want to be
sure you’re looking at the places where
you expect to find it,” she said.
Historically, said Craig, “Even in the US
we haven’t done as good a job as we
should have to detect and respond to [AR
pathogens].” He said, “With the AR Lab
Network, now we have an infrastructure
to do that, and I’m thankful and grateful
for all the hard work laboratorians have
put in to support the network; they are
fundamental to its success.”
Without laboratory data, Craig said,
“there’s really not a good understanding
about what [drug-resistant] strains are
developing, how they’re emerging and
what’s likely to be transmitted locally and
globally.” He warned, “If we’re not looking
for it, it’s going to disseminate secretly
and quietly around the world.” n
Containing the threat posed by drug-
resistant pathogens is an ongoing project.
Kainer said jurisdictions can assist
by making drug-resistant conditions
reportable and requiring isolate
submission; conducting tabletop exercises
with laboratorians, hospital and nursing
home risk managers, infection control
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Summer 2019 LAB MATTERS
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