C. auris questionnaire – the outcome

Overall 61 colleagues from 17 countries answered the questionnaire.  A large proportion (26 of 61) of the answers came from the UK, which might have to do with the fact that the first European outbreak was described in England.

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Of the respondents 32.8% said that their institution released a warning about C. auris.  Analyzing the data separately for the UK and the other participating countries, it became clear that the first European outbreak had impact on the preparedness. In the UK 42.3% of the institutions were warned about the unique capacities of C. auris, versus 25.7 in all other countries.  Regarding the existence of a written guideline dealing with C. auris, the differences were far less pronounced, namely 26.9% versus 20.0%, respectively.

53.9% of the UK responders believe that their lab can correctly diagnose C. auris, versus 31.4% in the other countries.  In addition, the proportion of responders, who didn’t know if their lab was prepared, was higher outside the UK (45.7% versus 26.9%, respectively).

Despite the emerging spread of  C. auris clusters this questionnaire is an indication that most institutions are not adequately prepared.  Obviously the sample is really small, but the outcome was predictable.  With an increasing body of literature, including papers on diagnostic methods and infection control measures, we should hope that the situation should change very soon.  Thus, don’t lean back, start writing.

 

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Candida auris part III. Are you prepared?

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MMWR just published on the ongoing transmission of Candida auris in the US, while at the same time PLOS Pathogens came with an excellent review on the topic.

By now I had the debatable pleasure to be around for the birth of a few “superbugs”, but this one is clearly putting a lot of effort into reaching the top of the list. I believe (classical pessimist) that many institutions still ignore this new adversary (or are even unaware), and most certainly have no game-plan to prevent its introduction and consequent spread.  In the MMWR publication the current recommendations for C. auris–colonized or infected patients were repeated, with only one change from previous recommendations, namely that a more effective (sporicidal) disinfectant is needed, but I seriously wonder who follows this guidance.

Thus, here it comes, another 30-seconds-questionaire.  Why?  Because I hope that you will prove me wrong and that we – the infection control people at the frontline – act on threat, instead of re-act once we are overrun.

Link to questions  https://www.surveymonkey.com/r/QCK9RWS

References

Notes from the Field: Ongoing Transmission of Candida auris in Health Care Facilities — United States, June 2016–May 2017. Weekly / May 19, 2017 / 66(19);514–515 https://www.cdc.gov/mmwr/volumes/66/wr/mm6619a7.htm?s_cid=mm6619a7_e

Chowdhary A, Sharma C, Meis J. Candida auris: A rapidly emerging cause of hospital-acquired multidrug-resistant fungal infections globally. PLOS Pathogens  https://doi.org/10.1371/journal.ppat.1006290 May 18, 2017

Tired of MRSA and CPE? The new superbug has arrived and it’s a yeast!

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All of a sudden, Candida auris seems to become the “new” global super villain.  Antimicrobial Resistance and Infection Control recently published the first, large European outbreak of C. auris in London with 50 cases (Schelenz et al.) and CDC just published the first 17 US cases (Vallabhaneni et al.).  While I believe that C. auris deserves our full attention, as it is a multi-resistant yeast, with increased MICs to all three major classes of antifungals, likes to evades traditional diagnostic methods, seems to be difficult to eradicate from the hospital environment, and causes invasive nosocomial infections with high mortality, I am still amazed by the fact that – despite the global society we live in – this “new” villain first has to come to Europe or even more important the US, before becoming a recognized “superbug”.

C. auris was first described in 2009 in Japan and cases of candidemia have since been reported from South Korea, India, South Africa, and Kuwait, in addition to unpublished reports from Colombia, Venezuela, and Pakistan. While “global migration” may come to mind for the rise of C. auris, it seems unlikely, as different continents and countries seem to have their own clones. Selection pressure due to the increasing use of antifungals in healthcare, livestock, and agriculture might be a more feasable explanation, but the true reasons for the recent emergence are still unknown.

I assume that many countries will issue guidelines with regard to diagnostic methods, reporting to health authorities, environmental cleaning and infection control, but as that might take time, those of us in infection control should get prepared and stay informed, not to be surprised to see C. auris emerging within their own setting.

Literature and links

Schelenz et al. First hospital outbreak of the globally emerging Candida auris in a European hospital, Antimicrobial Resistance & Infection Control20165:35
Chowdhary et al.  Multidrug resistant Candida auris: New kid on the block in hospital associated infections? Journal of Hospital Infection August 2016,  DOI: 10.1016/j.jhin.2016.08.004
Satoh et al., Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol, 2009;53:41-44
Lee et al., First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol, 2011;49:3139-42.
Chowdhary et al. New clonal strain of Candida auris, Delhi, India. Emerg Infect Dis, 2013; 19:1670-73.
CDC Q&A