Candida auris – An Unusual Yeast Causing Serious Infection
Over the past number of years discussion surrounding Candida auris has continued to increase. This pathogen is regularly discussed by the media and governmental bodies. It is of high concern to healthcare facilities. But what is Candida auris and why is it gaining so much attention? Candida auris is a fungal pathogen, to be more specific, it is a type of yeast. This pathogen was first reported in Japan in 2009 and has since been linked with healthcare associated infections (HAIs) on five continents (1). C. auris control is challenging due to the difficulty in identifying this pathogen in the clinical laboratory. Moreover, C. auris often exhibits high levels of multi drug resistance, leading to high rates of treatment failure with invasive infections (2). The United States Centers for Disease Control and Prevention (CDC) map new case reports worldwide (https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html). As of January 31st, 2019, a total of 560 confirmed clinical cases have been identified in the U.S. The most commonly observed invasive infection associated with C. auris has been blood stream infections, with mortality in the range of 30 to 60%. Patients involved generally have high healthcare exposure, however, infection may not be apparent until weeks after initial admission (2). The best treatment practice for C. auris infection has not been defined. C. auris appears to spread via patients and the environment. It has be isolated from the skin of affected patients as well a patient contact areas, such as sinks, medical equipment, furniture and mattresses (3, 4). Recent investigations suggest quaternary ammonium compounds may not be effective against C. auris (5). The US CDC recommend that sporicidal disinfectants (those listed on the U.S. EPA List K) be used where C. auris is of concern and provide several other points of interest in relation to C. auris transmission control, such as hand hygiene and contact precautions (https://www.cdc.gov/fungal/candida-auris/c-auris-infection-control.html). There is still a lot to learn regarding this pathogen, such as its origin in the natural environment, the reason for its sudden emergence and high antifungal resistance. Healthcare workers should remain ever vigilant for C. auris where Candida spp. infection is suspected due to its impact on patient mortality. Undoubtedly control of these outbreaks will prove a challenge until more information about this unusual pathogen become available. Providing care in accordance with best practice outlined by the CDC will be key until more defined control mechanisms become apparent.
1. Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. 2009. Candida auris sp . nov ., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol. Immunol: 53:41–44 2. Spivak ES, Hanson E. 2018. Candida auris : an Emerging Fungal Pathogen. J. Clin. Microbiol. 56:1–10. 3. Vallabhaneni S, Kallen A, Tsay S, Chow N, Welsh R, Kerins J, Kemble SK, Pacilli M, Black SR, Landon E, Ridgway J, Palmore TN, Zelzany A, Adams EH, Quinn M, Chaturvedi, S, Greenko J, Fernandez R, Southwick K, Furuya EY, Calfee DP, Hamula C, Patel G, Barrett P, Lafaro P, Berkow EL, Moulton-Meissner H, Noble-Wang J, Fagan RP, Jackson BR, Lockhart SR, Litvintseva AP, Chiller TM. 2017. Investigation of the First Seven Reported Cases of Candida auris , a Globally Emerging Invasive , Multidrug-Resistant Fungus — United States , May 2013 – August 2016. Amer. J. Transplant. 17:296-299 4. Schelenz S, Hagen F, Rhodes JL, Abdolrasouli A, Chowdhary A, Hall A, Ryan L, Shackleton J, Trimlett R, Meis JF, Armstrong-james D, Fisher MC. 2016. First hospital outbreak of the globally emerging Candida auris in a European hospital. Antimicrob Resist Infect Control. 5:35. 5. Cadnum JL, Shaikh AA, Christina T, Sankar T, Jencson AL, Larkin EL, Ghannoum MA, Donskey CJ. 2017. Effectiveness of Disinfectants Against Candida auris and Other Candida Species. Infect. Control and Hosp. Emidemiol. 38:1–4.
Hands can transfer dry surface biofilm, new research finds
Chowdhary et al. conducted a study investigating the role of healthcare worker’s hands in the transfer and spread of dry surface biofilm1. Dry surface biofilm has previously been found to be prevalent in healthcare environments and harbours multidrug resistant organisms2,3. In this new study, it was discovered that cultivated dry surface biofilms could be transferred by hands to other surfaces. Staphylococcus aureus biofilms were formed on glass or polycarbonate surfaces. With one touch a significant number of bacterial cells were transferred to the hand. These bacteria were then transferred to other surfaces via the hands. In fact, sufficient amounts of cells to cause infection were transferred to surfaces up to nineteen times after one touch of the dry surface biofilm. This study highlights that dry surface biofilm can become a persistent environmental source of pathogens that can be spread rapidly to others surfaces via healthcare worker or patients hands with just one touch. To prevent this spread please contact Medentech at Nicola, can you adjust the contact info here? to find out about the only US EPA approved solution for healthcare biofilms.
1Chowdhary D, Tahir S, Legge M, Hu H, Prvan T, Johani K, Whiteley G S, O’Glasbey T, Deva A K, Vickery K. 2018. Transfer of dry surface biofilm in healthcare environment: the role of healthcare worker’s hands as vehicles. J Hosp Infect: In press. 2Vickery K, Deva A, Jacombs A, Allan J, Valente P, Gosbell IB. 2012. Presence of biofilm containing viable multiresistant organisms despite terminal cleaning on clinical surfaces in an intensive care unit. J Hosp Infect 80:52–55. 3Hu H, Johani K, Gosbell IB, Jacombs ASW, Almatroudi A, Whiteley GS, Deva AK, Jensen S, Vickery K. 2015. Intensive care unit environmental surfaces are contaminated by multidrug-resistant bacteria in biofilms: Combined results of conventional culture, pyrosequencing, scanning electron microscopy, and confocal laser microscopy. J Hosp Infect 91:35–44.
New revelation about hospital bed sheets – transmission vector for dry surface biofilm
Recent work by a research group at Macquarie University in Australia have highlighted some startling findings regarding hospital bed sheets. Previous work by this research group has shown that dry surface biofilm is present on up to 93% of hospital surfaces, with over half of these biofilms containing multiple drug resistant organisms. One such surface that may harbour dry surface biofilm are the patient mattresses. This is exacerbated by the fact that patients continually shed microorganisms into their immediate environment. Researchers found that pathogenic bacteria grown in a dry surface biofilm could be transferred through cotton sheets at rates of 100 – 1000 cells up to 20 consecutive times. This could potentially aid the spread of pathogens in a hospital setting, highlighting the importance of mattress cleaning and disinfection. Only one product has been approved by the US EPA as being effective against healthcare associated biofilms, Medentech’s Klorkleen 2.