Fungal fear in UK hospitals - News & Features
16 August 2017
Hospitals in the UK have found more than 200 patients colonized or infected with the multidrug-resistant fungus Candida auris, according to a new report from Public Health England (PHE).
Approximately one quarter of the cases, which have been detected at more than 55 hospitals across the UK, are clinical infections, including 27 patients who developed bloodstream infections. The other patients haven’t shown any sign of infection, a PHE microbiologist told Reuters. No deaths have been attributed to infection.
NHS trusts have been ordered to carry out deep cleans of all affected areas after more than 200 patients were found to be infected or carrying the potentially fatal pathogen.
Candida auris was first identified in Japan in 2009, in the ear canal of a 70-year-old woman. Since then it has spread quickly around the globe, emerging in at least five continents, with the first UK case detected in 2013.
Dr Colin Brown, from PHE's national infection service, said most of the UK cases had been detected by screening, rather than investigations for patients with symptoms. However, 27 patients have developed bloodstream infections.
"Our enhanced surveillance shows a low risk to patients in healthcare settings. Most cases detected have not shown symptoms or developed an infection as a result of the fungus.
"NHS hospitals that have experienced outbreaks of Candida auris have not found it to be the cause of death in any patients."
He said PHE had updated its infection-control guidance for hospitals and nursing homes on managing outbreaks of Candida auris, together with a leaflet for patients who may have the fungal infection.
What makes C. auris so problematic?
1. Multidrug resistant (some strains are resistant to all three major antifungal classes e.g. polyenes, azoles and echinocandins).
2. Difficult to identify in clinical laboratory settings without a high degree of suspicion and access to mass spectrometry or sequencing facilities.
3. Affects the most vulnerable and debilitated patients e.g. intensive care units.
4. High rates of colonisation with the ability to cause life-threatening infections.
5. Associated with person-to-person and environment-to-person spread.
6. Difficult to eradicate outbreaks reported in critical care units
Writing in the forthcoming issue of Microbiologist, Deborah E.A. Lockhart (MRC Centre for Medical Mycology at the University of Aberdeen) observed:
“At present it is unclear if C. auris may reside in the oral cavity but it is commonly reported in the respiratory tract. Throat swabs are one of the body sites selected to screen for carriage in hospital so it is highly plausible that transient oral colonisation is possible together with a theoretical risk of causing localised and systemic disease.
“Fungi know neither geographic nor anatomical boundaries when the equilibrium tips. Future faces might have an altogether unrecognizable reflection. Vigilance and concerted efforts by scientists and clinicians are critical to ensure C. auris shalt not conquer all."