Fungal drug resistance is spreading quick, CDC says

A fungus that is often resistant to drugs has been spreading at an “alarming rate” in healthcare facilities across the United States, according to the Centers for Disease Control and Prevention.

Candida auris is an emerging fungus that is serious and potentially fatal for hospital patients, particularly those with multiple medical conditions.

The fungus was first identified in Asia in 2009, and the first case in the US dates back to 2013. Candida auris was limited to New York City and Chicago, but has since been detected in more than half of U.S. states and has become endemic in some areas, according to a CDC report published Monday in the Annals of Internal Medicine.

From 2019 to 2021, 17 states detected their first-ever cases of the fungus. California, the Mid-Atlantic region, the Midwest, Texas and Florida all had increased transmission during this time, according to the CDC.

Infections have increased by about 200% from about 500 infections in 2019 to more than 1,400 in 2021. The fungus has spread most strongly in long-term hospitals for people with serious illnesses who require ongoing treatment, according to the CDC.

Symptoms can vary widely depending on the type of infection, but fever and chills are the most common. People with weakened immune systems, diabetics who take many antibiotics, or who have breathing tubes, feeding tubes, and catheters are more likely to be affected.

A 2021 CDC report found that two outbreaks of the fungus, which was resistant to echinocandin, had a 30% mortality rate over 30 days. The cases studied in the outbreaks were mostly critically ill patients in long-term care facilities, so the exact contribution of Candida auris to the deaths was unclear. The outbreaks occurred in Washington, DC and Texas.

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Candida auris is often resistant to drugs used to treat fungal infections. In 2020, 86% of samples were resistant to a class of antifungal drugs called azoles, and 26% were resistant to amphotericin B, according to the CDC.

Just over 1% of samples tested in 2020 were strains resistant to the main class of drugs used to treat such infections, called echinocandins, up from 0.4% in 2018. The CDC said that although resistance to Echinocandin is still uncommon, the number of such cases increasing in 2021 has tripled compared to the previous two years.

“Even this subtle increase is concerning because echinocandins are the first-line therapy for invasive candida infections and most cauris infections,” the CDC said in its report.

The CDC attributed the rapid spread of the fungus to a decline in infection control during the pandemic due to strains on the healthcare system, from staffing and equipment shortages to an increase in patient burden and increased use of antibiotics.

“The rapid rise and geographic spread of cases is worrying and underscores the need for continuous surveillance, expanded laboratory capacity, faster diagnostic testing, and adherence to proven infection prevention and control practices,” said CDC epidemiologist Dr. Meghan Lyman, the report’s lead author.