Stewardship / Resistance Scan for May 18, 2017

Candida auris cases rise
Antibiotic use in South Korea

CDC reports count of US Candida auris infections up to 77 cases

In today's Morbidity and Mortality Weekly Report, investigators from the Centers for Disease Control and Prevention (CDC) and several state health departments say a total of 77 clinical cases of the emerging multidrug-resistant fungus Candida auris have now been reported from seven states. New York has the most reported cases with 53, followed by New Jersey (16), Illinois (4), Indiana (1), Maryland (1), Massachusetts (1), and Oklahoma (1).

C auris was originally discovered in 2009 in Japan and since then has emerged as a global health threat due to its growing resistance to all three major classes of antifungals used to treat Candida infections. The CDC estimates the mortality rate of C auris infections at approximately 60%.

Among the 77 clinical cases, median patient age was 70 years and 55% were male, and nearly all patients had underlying health conditions and extensive exposure to healthcare facilities. The report says epidemiological connections have been found between most cases, with further investigation revealing that many of the New York and New Jersey patients had overlapping stays at interconnected long-term care facilities and acute care hospitals within a limited geographic area. The case in Massachusetts was linked to the Illinois cases, and the cases in Oklahoma and Maryland involved patients who had received healthcare outside the country.

Antifungal susceptibility tests of the first 35 clinical isolates found that 30 (86%) were resistant to fluconazole, 15 (43%) were resistant to amphotericin B, and 1 (3%) was resistant to echinocandins. Whole-genome sequencing showed that isolates from within each state were highly related to one another and linked to isolates found in South Asia and South America, suggesting they had been introduced from outside the country and then transmitted locally.

Screening of 390 close contacts, primarily individuals who were on the same hospital ward as the infected patients, identified an additional 45 patients who were colonized with C auris (24 in New Jersey, 17 in New York, and 4 in Illinois). Environmental testing detected C auris on a variety of hospital surfaces.

To help curb the spread of the fungus, the CDC recommends using standard and contact precautions for infected and colonized patients, housing patients in private rooms, cleaning patient rooms daily with a disinfectant active against Clostridium difficile, and informing receiving healthcare facilities when an infected or colonized patient is being transferred.
May 18 MMWR Notes from the Field


Antibiotic use rises in South Korea

A review of a large health insurance claims database has found that antibiotic usage in South Korea rose by more than 17% from 2007 to 2014, researchers reported yesterday in PLoS One.

To investigate antibiotic usage in South Korea, a country known for high utilization of antibiotics and high rates of antibiotic resistance, researchers used data from the Health Insurance Review & Assessment Service, which represents nearly the entire South Korean population. Annual usage was calculated as defined daily doses per 1,000 inhabitants per day (DID). Antibiotic usage was analyzed for the entire population and for various subgroups.

Overall, the researchers found that total antibiotic usage in South Korea rose from 23.5 DID in 2007 to 27.7 DID in 2014, with inpatient use seeing a slight decrease but use among outpatients, male and female patients, and all age groups seeing an increase. Antibiotic use was highest among patients younger than age 6 in all years and rose from 47 DID in 2007 to 59.21 in 2014. DIDs of penicillins, cephalosporins, macrolides, and fluoroquinolones all increased over time.

The authors of the study say the findings could be a useful guide for designing public health intervention strategies to promote appropriate antibiotic use.
May 17 PLoS One study

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