CDC Discusses Candida auris: What if We Do Nothing—Or Not Enough

Collaboration among health care workers is crucial in diagnosing and preventing the spread of deadly Candida auris (C auris). Neglecting appropriate preventive measures can lead to severe consequences.

To address these possible outcomes, Infection Control Today^® (ICT^®) consulted with the CDC and spoke with Megan Lyman, MD, medical officer, Mycotic Diseases Branch, CDC, and Danielle A. Rankin, PhD, MPH, health scientist, Division of Healthcare Quality and Promotion, Prevention and Response Branch, Antimicrobial-Resistance Team, CDC. This initial interview was conducted in collaboration with our colleague Chris Spivey, editorial director for Pharmaceutical Technology, Pharmaceutical Technology Europe, and BioPharm International.

This is the third installment in a series of four. The first is here. The second installment is here. The fourth installment is here.

ICT: What will the future look like if nothing—or not enough—is done to prevent C auris from spreading?

Danielle A. Rankin, PhD, MPH: If we do nothing, it's likely C auris will continue to spread throughout our health care facilities and may become endemic, allowing C auris to become an even greater risk to our patient populations. And in addition, we could also see the increasing level of resistance among C auris isolates.

Megan Lyman, MD: Just on resistance, only 3 main antifungal drug classes can be used for invasive Candida infections, including C auris. There was also an increase in a Candida-resistant cases that we've detected and [had] evidence of transmission, which is particularly concerning because it is our first line therapy for invasive Candida infections, including C auris.

ICT: What other pathogens lurking in the background that we need to worry about?

ML: There are many fungal pathogens; it's a whole kingdom. There are many changes, and we have seen more emerging fungal pathogens increasing resistance; C auris is a great example. We're continuing to monitor that. But there are some things going on, including climate change that may be selecting for some of these emerging pathogens to start popping up now. And things like antifungal and antimicrobial use are increasing and changing, and that's selecting for more resistant, emerging pathogens.

DR: So as Megan said, in addition to C auris, we also have seen, throughout the years, carbapenemase-producing organisms. These are organisms that are resistant to our carpet penname antibiotics, but they also possess an enzyme that can transfer between bacterial taxa carbapenemase enzyme is where it makes the bacteria produce carbapenemases where it makes it resistant to all those carbapenem antibiotics. And so those carbapenemase carbapenemase producing organisms are also, as Megan had indicated, sometimes we see them where patients have both C auris in some of our carbapenemase-producing organisms. Still, it's not always that we see them coincide, we do see patients who also have these carbapenemase organisms as well on their own.

ML: In facilities where we see transmission of one, we're often worried that they are at higher risk for having transmission of the other if it's introduced.

DR: In addition, as Megan had indicated, for C auris, our team specifically focuses on the carbapenemase-producing organisms and does surveillance alongside but separately from the Mycotic Division. We focus solely on the carbapenemase-producing organisms.