First Cases of Drug-Resistant Fungal Infection Reported in United States
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First Cases of Drug-Resistant Fungal Infection Reported in United States

Thirteen cases of the infection, which is sometimes fatal, have been identified

November 8, 2016

The Centers for Disease Control and Prevention (CDC) has announced that thirteen cases of candida auris, a fungal infection that is serious and, at times, fatal, have been identified in the U.S.

Seven cases took place between May 2013 and August 2016, while the other six were not identified until after this period and are still being investigated.

The infection is frequently resistant to antifungal medications and often occur in patients who are hospitalized. Together with numerous state and local health departments, the CDC has been investigating reports of the infection since June 2016, and it expects to continue doing so as more people become aware of candida auris.

"We need to act now to better understand, contain and stop the spread of this drug-resistant fungus," said CDC Director Tom Frieden, M.D., M.P.H. "This is an emerging threat, and we need to protect vulnerable patients and others."

Of the seven cases mentioned above, patients with the infection were reported in four states: New York, Illinois, Maryland, and New Jersey. Each patient had a serious underlying medical condition and had been in the hospital for an average of 18 days when the infection was discovered. Four of the patients died, but it is not clear whether the deaths were linked to the infection or the other health conditions. Twice, two patients had received treatment at the same hospital or long-term care facility and had fungal strains that were almost identical, which suggests that the infection may be spread in healthcare settings.

Six out of the seven cases were identified by a retrospective review of records from the hospitals and reference laboratories. Specialized laboratory methods are necessary to identify the infection due to the ease with which it can be confused with another kind of candida infection, which may result in the patient not receiving the appropriate treatment.

Most of the strains in U.S. patients—71 percent—showed a certain amount of resistance to drugs, making it more difficult to treat the infection. Samples of strains taken from people in other countries have been discovered to be resistant to all three of the major classes of antifungal medications. However, none of the U.S. strains in the seven cases were resistant to all three classes. Laboratory testing revealed a relationship between the U.S. strains and strains in South Asia and South America, although none of the patients had travelled to or had any direct connection with those places. It is likely that the majority of patients contracted the infections locally.

"It appears that C. auris arrived in the United States only in the past few years," said Tom Chiller, M.D., M.P.H., chief of CDC's Mycotic Diseases Branch. "We're working hard with partners to better understand this fungus and how it spreads so we can improve infection control recommendations and help protect people."

Healthcare facilities housing a patient with the infection should carry out thorough daily and after-discharge cleaning of the patient's room using an EPA-registered disinfectant that is active against fungi. Any cases of candida auris should be reported to CDC as well as state and local health departments.