UK warns about drug-resistant Candida infections

Health officials in the United Kingdom said late last week that an emerging drug-resistant fungus has been identified in England, just 7 days after US officials warned about the same pathogen.

The pathogen, Candida auris, is a type of yeast that was first isolated from the ear of a Japanese patient in 2009, and since then has been reported in eight other countries, including Great Britain. The pathogen has most commonly caused healthcare-associated invasive infections such as bloodstream infections, wound infections, and ear infections. 

According to a report from Public Health England (PHE), sporadic cases of C auris have been identified throughout the country since 2013. But since April 2015, an adult critical care facility in England has been dealing with a C auris outbreak involving more than 40 patients.

"The hospital outbreak has been difficult to control, despite enhanced infection control interventions, including regular patient screening, environmental decontamination and ward closure," PHE said in its Jul 1 report.

Prolonged hospital outbreaks of C auris have also been reported in India, Pakistan, Venezuela, and Colombia, according to PHE.

Testing of C auris isolates in the United Kingdom and other countries where it has been detected has indicated that the pathogen is resistant to fluconazole, an antibiotic that is commonly used to treat fungal infection. But testing has also demonstrated varying levels of resistance to the three main classes of antifungal drugs (azoles, echinocandins, and polyenes), which is raising concerns that treatment options could be limited.

Propensity for hospital transmission

The PHE announcement comes on the heels of a clinical alert about C auris issued by the US Centers for Disease Control and Prevention (CDC) on Jun 24. The agency warned US healthcare facilities to be on the lookout for C auris, which can be difficult to identify.

The CDC said commercially available biochemical tests cannot differentiate C auris from other invasive Candida infections, such as C haemulonii. Molecular tests are needed to correctly identify the pathogen.

While the drug-resistant nature of the pathogen is a major concern, another concern being voiced by the CDC and PHE is that C auris appears to behave differently than other invasive Candida infections, which generally occur when a patient's own Candida yeasts enter the bloodstream. The international C auris infections that have been reported appear to have come from the hospital environment.

"C. auris appears to be unlike other pathogenic yeast species in its propensity for transmission between hospital patients," PHE said in its report.

In addition, testing of isolates by the CDC suggests that the fungal infection is emerging simultaneously on different continents, as the isolates within each country are similar to one another but different across continents.

According to the CDC, 60% percent of people with C auris infections have died, although that statistic is based on a limited number of patients, and many of those patients had other serious illnesses.

In advance of its Jul 1 report, PHE on Jun 27 issued laboratory and clinical guidance on the disease.

See also:

Jul 1 PHE report

Jun 29 CIDRAP News story, "CDC issues warning on multidrug-resistant yeast infection"

Jun 27 PHE laboratory and clinical guidance

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