Candida auris (C. auris)—an emerging fungus considered an urgent antimicrobial resistance (AR) threat—is on the rise in the United States. According to Centers for Disease Control and Prevention (CDC) data published in the Annals of Internal Medicine, C. auris spread at an alarming rate in U.S. healthcare facilities from 2020 to 2021. In fact, the number of cases resistant to echinocandins in 2021 was about three times that in each of the previous two years.
According to the CDC’s 2022 Special Report: COVID-19 U.S. Impact on AR, there were 171 clinical cases in 2017, 329 cases in 2018, and 466 cases in 2019. In 2020, there were 754 cases—representing a 60-percent increase. The CDC has categorized C. auris as an “urgent” pathogen based on the level of concern to human health.
What’s Driving the Rise in Cases?
Historically, C. auris has been a threat in long-term care and other post-acute care facilities. Even before the pandemic, gaps in infection control causes transmission of C. auris in acute care hospitals, as well.
The COVID-19 crisis appears to have worsened the issue. As the CDC report notes, “The increase of C. auris spread and findings from public health investigations suggest it may have been exacerbated by pandemic-related strain on the health care and public health systems, which included staff and equipment shortages, increased patient burden and disease severity, increased antimicrobial use, changes in patient movement patterns, and poor implementation of non–COVID-19 IPC measures.”
Regardless of specific causes, the rise in echinocandin-resistant cases and the evidence of transmission is alarming because echinocandins are first-line therapy for invasive Candida infections—including C. auris.
How Should Infection Prevention Teams Respond?
Several new antifungal medications, including Ibrexafungerp and Manogepix, are now in development. Even so, more research is needed to understand outcomes for patients with these highly resistant strains. Such research is essential to guiding treatment.
In the meantime, the CDC’s findings highlight the need for improved detection and infection control practices to prevent the spread of C. auris. As always, adhere closely to the infection and prevention control fundamentals for mitigating transmission of any multi-drug resistant organism (MDRO).
In addition to following the fundamentals, healthcare organizations should explore new interventions to prevent transmission. These include faster and more accessible testing methods, improved disinfection methods, increased capacity for antifungal susceptibility testing, and new antifungal drugs.
Learn how ECRI can help you address the need for more sophisticated infection prevention and control capabilities.