Drug-Resistant Fungus in Healthcare Settings
A lethal, drug-resistant fungus is rapidly spreading through U.S. hospitals, endangering vulnerable patients and testing medical facilities’ infection control capabilities. The CDC classifies C. auris as an “urgent threat,” with a mortality rate of 30-60% among infected individuals. California leads with 1,566 cases, but Georgia and Florida have also reported significant outbreaks. The fungus spreads via contact with infected patients, contaminated surfaces, and medical equipment.
Rising Threat to America’s Healthcare System
First identified in the United States in 2016, Candida auris has become a significant challenge for healthcare facilities nationwide. Cases have more than doubled annually, reaching an alarming 4,514 infections in 2023. California currently reports the highest concentration with 1,566 cases, while recent surges have also been documented in Georgia and Florida healthcare facilities. The rapid geographical spread has raised concerns among health officials about the fungus’s potential to become endemic in American hospitals.
The fungus primarily affects already-ill patients, particularly those with invasive medical devices such as catheters, breathing tubes, or feeding tubes. What makes C. auris particularly dangerous is its resistance to the limited arsenal of antifungal medications available to treat fungal infections. This resistance, combined with its ability to spread rapidly through healthcare environments, led the CDC to classify it as an “urgent threat” in 2023.
Why C. auris Presents Unique Challenges
Unlike many other infectious agents, Candida auris can persist on surfaces for extended periods, colonize patients for months without symptoms, and resist standard cleaning protocols. Most concerning for infection control specialists is that many common hospital disinfectants, particularly those containing quaternary ammonia compounds, prove ineffective against this persistent fungus. This resistance to routine cleaning agents has complicated containment efforts significantly.
The CDC recommends that healthcare facilities use EPA-registered hospital-grade disinfectants specifically effective against C. auris (List P) or against Clostridioides difficile spores (List K) when List P products are unavailable. “No-touch” disinfection technologies like ultraviolet irradiation and vaporized hydrogen peroxide are being employed as supplementary measures, though their effectiveness against C. auris remains under investigation.
Protecting Vulnerable Patients
Patients infected with Candida auris face serious risks, with mortality rates estimated between 30% and 60%. While many infected individuals have other serious underlying conditions, C. auris can be the decisive factor that overwhelms already compromised immune systems. Hospitals across the country are implementing strict screening and isolation procedures to identify and separate infected or colonized patients.
“Most of the patients that get infections with Candida auris are themselves pretty sick to start with. This is something that can push people over the edge and become life-threatening.”
The CDC recommends placing infected patients on contact precautions, preferably in single-patient rooms. When single rooms are limited, facilities may cohort patients with the same C. auris status. Healthcare workers must follow strict hand hygiene practices, with alcohol-based sanitizers being acceptable unless hands are visibly soiled. Unfortunately, no specific intervention has been proven to reduce or eliminate C. auris colonization once established, though chlorhexidine has shown some laboratory activity against the fungus.
Strengthening Healthcare Defense Systems
Controlling the spread of Candida auris requires diligent attention to shared medical equipment, which should be thoroughly cleaned and disinfected after each use. Clear responsibilities for healthcare personnel regarding equipment cleaning are essential. Facilities must also implement robust communication systems to alert receiving facilities when transferring patients with C. auris colonization or infection.
“The goal is, first and foremost, to keep the people in your hospital safe. When somebody comes in for a procedure, they’re not expecting to go home with a life-threatening illness or having spent time in an ICU from a hospital infection.”
Healthcare facilities already equipped to manage other multidrug-resistant organisms (MDROs) or Clostridioides difficile generally have the infrastructure needed to manage C. auris. However, the CDC emphasizes that continued vigilance, expanded laboratory capacity, faster diagnostic testing, and strict adherence to infection prevention protocols are crucial to containing this emerging threat and protecting America’s most vulnerable patients.
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