Report suggests transmission of pan-resistant C. auris strains in US hospitals
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A new report provides the first evidence that pan-resistant strains of Candida auris may have been transmitted in U.S. hospitals, researchers said.
The report, published this week in MMWR, details two independent clusters of pan- or echinocandin-resistant C. auris cases among patients with overlapping inpatient exposures and no echinocandin use. The cases were detected between January and April of this year in Washington, D.C., and Texas.
“Echinocandin resistance is a concerning clinical and public health threat, particularly when coupled with resistance to azole and amphotericin B (pan-resistance),” Meghan Lyman, MD, a medical officer in CDC's Mycotic Diseases Branch, and colleagues wrote.
“Pan-resistant C. auris isolates have been reported previously, although rarely, from the United States and other countries,” they wrote, adding that three pan-resistant C. auris cases reported in New York “developed resistance following echinocandin treatment and lacked epidemiologic links or common health care, suggesting that resistance resulted from antifungal pressure rather than via person-to-person transmission.”
According to Lyman and colleagues, among 101 cases of C. auris detected in Washington during the 4-month period, three isolates identified through skin colonization screening at a long-term care facility for severely ill patients were pan-resistant.
In Texas, two out of 22 cases of C. auris detected during the same period at two facilities that share patients in the same city were pan-resistant and five were resistant to both echinocandins and fluconazole, Lyman and colleagues reported.
“These two simultaneous, independent clusters of pan- or echinocandin-resistant C. auris cases in patients with overlapping inpatient health care exposures and without previous echinocandin use provide the first evidence suggesting that pan- or echinocandin-resistant C. auris strains might have been transmitted in U.S. health care settings,” the researchers wrote. “Surveillance, public health reporting, and infection control measures are critical to containing further spread.”
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