A Wave of Candida auris infections: Crashing in Hospitals Nationwide

by Erica Mitchell | April 3 2023 | Infection Control, Hospitals, Germs, HAIs, Antibiotic Resistance, Epidemiology, Long-term care facilities, Nursing homes, MDROs | 0 Comments

candida wave 2023-01We've covered Candida auris in this blog before. Not only has it been one of the pathogens of concern cited by the Centers for Disease Control and Prevention, this fungus also infected record numbers of inpatients during the COVID-19 pandemic. This disease-causing pathogen has hit headlines once again, this time brining attention to troubling increases in rates and resistance. What can hospitals - and patients - do to avoid this dangerous hospital-associated infection?

Candida auris infections have been tracked in the United States since 2016, when just 53 infections were reported. At first, cases were limited to the Chicago and New York metro areas, focused mostly in long-term facilities. As time passed, however, the fungus spread, and can now be found in over 25 states (see year-by-year spread here). Increases were substantial enough (and widespread enough, reaching 17 new US states) that in 2018 that it became "nationally notifiable," that is, every case had to be reported immediately to the National Notifiable Diseases Surveillance System. As of the most recent reports, there were 1, 471 cases reported in 2021. Additionally, screening cases (where the individual carries the fungus but has not developed an infection but is capable of spreading the fungus) reached 4,041.

Not only did cases skyrocket, so did the percentage of cases caused by drug-resistant strains. 2021 saw three times the number of cases caused by strains resistant to echinocandins, the first-line treatment for this type of infection.

The good news is that Candida auris poses no threat to healthy people.

The bad news is that individuals with long hospital stays, indwelling devices, and weakened immune systems are particularly at risk. This makes Candida auris a primarily hospital-associated infection, which also makes is preventable.

The CDC reports that "poor general infection prevention and control practices in healthcare facilities" is one of the reasons this fugus has spread so dramatically in the past decade. This lapse in infection control is due in part to stressors from the pandemic, and also ongoing staff and equipment shortages brought on by complex economic and demographic factors affected the entire medical field. 

So what can be done to slow the spread of this dangerous pathogen in hospitals and healthcare facilities since what is currently being done, including terminal cleaning, UV radiation, and hydrogen peroxide misting, is not doing enough? Each of these methods - and all other cleaning - has the same flaw: Its a one-time process that leaves surfaces and patients vulnerable between application. Surfaces may be clean for minutes after wiped, radiated, or misted, but quickly become re-contaminated, becoming more and more dirty every minutes until the next cleaning opportunity, which are often separated by hours. And in the cases of Candida auris, any bit that is left behind can survive for weeks.

What is needed is a permanent, continuous solution that destroys Candida auris (and other pathogens) before they have a chance to be transmitted to a vulnerable patient. That solution could be copper-infused self-sanitizing surfaces, which have demonstrated to kill Candida in third-party laboratory tests. Imagine if all the high-touch surfaces (yes, the surface itself) surrounding a patient could continuously kill Candida, all day and in between routine cleaning? And not just Candida, but MRSA, C. difficile, and other multi-drug resistant organisms? That kind of intervention could help finally stop Candida in its tracks.