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C. auris introduced into US several times from 4 global regions
Candida auris, an emerging, pathogenic fungus that can cause deadly invasive infections, was introduced several times into the United States from four global regions, according to recently published study findings.
C . auris is often multidrug resistant, with some isolates from other countries showing resistance to all three major classes of antifungals. It can spread in health care settings, causing outbreaks. The fungus was first isolated in 2009 from a Japanese patient’s ear. Since then, it has been reported in more than 30 countries on six continents, including the U.S., according to Nancy A. Chow, PhD, a molecular microbiologist in the CDC’s Mycotic Diseases Branch, and colleagues.
“We performed this study in response to the emergence and spread of Candida auris infections in U.S. health care facilities,” Chow told Infectious Disease News. “Since the first reported U.S. cases of C. auris in 2016, we have now identified over 400 patients with C. auris infections and more than 700 patients who are colonized with C. auris on their skin and other body sites. We wanted to use cutting edge whole-genome sequencing technology to better understand how C. auris emerged and spread in the United States.”
Chow and colleagues used whole-genome sequencing to compare isolates collected from patients in 10 U.S. states — including New York, which has seen the most cases by far — to isolates from seven other countries. They integrated data from epidemiological investigations — including whether patients had shared a room or ward with a patient with C. auris — and patients’ travel histories and evaluated the genetic diversity of C. auris within each patient.
Between May 11, 2013, and Aug. 31, 2017, Chow and colleagues collected C. auris isolates corresponding to 133 cases — 73 clinical cases and 60 screening cases linked to contact investigations or point prevalence surveys. Of the clinical cases, 90% (n = 66) involved isolates related to south Asian isolates, 7% (n = 5) to South American isolates, and 1% (n = 1) each to African and east Asian isolates. According to the study findings, 60 cases were identified in New York and New Jersey. These isolates were genetically distinct, but related to south Asian isolates, Chow and colleagues said. Genomic data showed that 7% (n = 5) of clinical cases were acquired through health care exposures abroad.
According to Chow, this evidence suggests that C. auris was introduced multiple times into the U.S. from four global regions — Africa, east Asia, South America and south Asia. The study included several examples of patients who received health care abroad and were found to have a strain of C. auris that maps back to that part of the world.
However, Chow said a vast majority of cases in the U.S. are a result of local transmission. She called C. auris “a serious public health threat.”
“The findings from this study show that receiving health care abroad in certain countries is a risk for having infection or colonization with C. auris and that once introduced into the health care setting in the U.S., it can spread easily If it is not immediately recognized and if infection control measures are not taken to prevent transmission.”– by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.