As the US healthcare system has taken blow after blow from the COVID pandemic, diseases of all kinds, from HIV to congenital syphilisswept across the country. Last week, a national survey by the Centers for Disease Control and Prevention found that outbreaks of new drug-resistant fungi were also growing at an “alarming” rate in hospitals from 2019 to 2020.
Annual cases of opportunistic intractable yeast candida golden nearly tripled from 476 in 2019 to 1,471 in 2021.according to a recent CDC report that was published in Annals of Internal Medicine. Infectious disease experts say the COVID pandemic has likely exacerbated an already growing outbreak of the fungus, diverting attention and resources needed to slow down. C. auris transmission of infection. In some cases, the practices needed to protect healthcare workers and patients from COVID, such as reusing high-demand masks, may have increased the risk of spreading the fungus.
“Problems with [C. auris] Infection control existed before the advent of COVID-19,” says Megan Lyman, an epidemiologist specializing in mycology at the CDC and lead author of the study. “But I think some of the changes that were made to this strange world had consequences that we didn’t know about at the time.”
ace C. auris becomes more common, it will make recovery from catastrophic injury or illness more dangerous for vulnerable patients, such as those who are immunocompromised and with pre-existing medical conditions. “Almost everyone will be hospitalized or have a loved one hospitalized at some point in their lives,” says Lucy Witt, an infectious disease physician at Emory University who was not involved in the recent study. “This is everyone’s problem.”
C. auris closely related to several common yeasts that live in the human digestive tract, such as fungal microorganisms albicans, which causes mild infections. But C. auris causes more anxiety than its counterparts. Yeast lives on the skin, not in the gut, which allows it to spread easily from person to person. IN 2021 survey of one skilled nursing facility Conducted by the CDC and the Chicago Department of Public Health (CDPH), swabs found fungus on window sills, bed rails and doorknobs both inside and outside of patients’ rooms. It sticks to surfaces for weeks and is immune to some common disinfectants.
For most healthy people C. auris does not spread throughout the body from the skin. It’s just becomes a deadly problem for people with weakened immune systems. In these cases, “patients tend to be really sick at baseline,” Lyman says.
Infection in healthcare settings is the cause of most, if not all, according to a new CDC report. C. auris cases in the United States, with most diagnosed in long-term care hospitals and skilled care facilities. Patients treated in these facilities typically have an intravenous catheter, catheter, or other invasive medical device that creates a passage between the skin and internal organs. When ingested, yeast can cause opportunistic diseases, such as those recovering from organ transplants, chemotherapy, or other medical procedures that destroy the body’s innate immune defenses. Sepsis and fever are common symptoms, and studies have shown a fatality rate of 30 to 60 percent. WITH C. auris was first identified in the United States in 2016, reported nosocomial infections nearly doubled.
And ‘to add harm to harm, [C. auris] able to resist many antifungal drugs,” says Ilan Schwartz, a fungal infection specialist at Duke University School of Medicine.
For the treatment of patients with C. auris against about half a dozen classes of antibiotics used to treat bacterial infections. Resistance to any one drug severely limits the ability of clinicians to suppress infection. By 2020, nine patients in the US had infections resistant to echinocandins, the first-choice antifungal drugs doctors use to treat cancer, according to a new study. C. auris. By 2021, the CDC identified 27 cases of echinocandin resistance, seven of which were resistant to all antifungals.
Pharmaceutical companies are currently testing several new antifungal drugs, making it “a very, very exciting time to study fungal infections,” Schwartz says. An oral drug similar to cutting-edge echinocandins and already approved for treating vaginal yeast infections is being tested for use against systemic infections. Candida .
But the best way to control the spread of drug-resistant organisms is to constantly clean up.
The Chicago health system has been at the forefront of the fight against C. auris infections since 2016, when his hospitals for the first time Outbreak in the US The city’s Department of Public Health began tracking agencies that reported the fungus. At one skilled nursing facility in 2018, 43 percent of residents tested had marks on their skin. In eight months of follow-up testing, that number rose to 71 percent. The rapid rise in cases forced city health officials to coordinate a response that included handwashing training and the use of fluorescent markers to assess how thoroughly rooms are being cleaned.
“A lot of what came out of it was a recognition that people do more than just clean a room; they really help with the care of residents,” says Stephanie Black, medical director of the CDPH infectious disease program. It was also important to convince administrators that “you need to spend your resources cleaning up the environment,” she says. Prior to the outbreak at this nursing facility, staff used the correct cleaning products, but they didn’t necessarily leave these materials on surfaces long enough for them to take effect. The improvement also came from simply clarifying cleaning responsibilities, such as “defining who cleans the IV stands, who cleans the IV machine,” Black says. In response to the outreach by the CDPH, the nursing facility added dozens of hand sanitizer dispensers and hired another full-time cleaner to focus on the fungus. The level of fungi at the facility stabilized during the study. (In a letter to Scientific AmericanThe CDPH has stated that it cannot disclose more recent site-specific prevalence data.)
Control measures have helped slow the outbreak, but “you see how it gets lost in all of the COVID-related issues,” Black says. She adds that many of the nurses CDPH trained have quit their jobs, “so there’s a lot of retraining.” Nursing staff, hard hit by the COVID pandemic, are essential in dealing with outbreaks. Across the country, nurses have quit or taken on traveling jobs, and a quarter of hospitals reported staff shortages in March 2022.
Although Witt says the new report does not provide “detailed details” of what exactly caused the rapid surge C. golden, researchers say the pandemic is likely exacerbating outbreaks. COVID caused an increase in many healthcare-associated infections. Organ damage by the disease-causing virus leaves people vulnerable to opportunistic infections, and steroids and antibiotics used to treat COVID complications can increase the risk fungal infection. Health care workers who resorted to reusing masks and gloves to slow the transmission of a respiratory disease may have created a vector for the organism to travel across surfaces. “Everyone was trying to do their best under dire circumstances,” Lyman says.
Even as the burden of COVID eases, understaffing and burnout are likely to be ongoing sources of risk. “But we don’t want people to be hopeless,” Lyman says. “Certainly there are means capable of controlling [C. auris] outbreaks.” The researchers, however, say that replicating this success will likely require significant investment in the health departments that coordinate the response, as well as in the medical workers on the ground.
