First cases of drug resistant fungal infection reported in the U.S.

by Chia-Yi Hou | July 26, 2021 | Jul. 26, 2021

Story at a glance

The CDC reports a handful of fungal infection cases that are resistant to all available treatments.
Health experts think these strains may be transmitted at the health care facilities where patients are being treated.
They recommend that health care professionals actively screen for the fungus in their patients, especially in long-term care facilities.

Public health experts are concerned about cases of a fungus called Candida auris (C. auris) in the U.S. It’s been reported in the country previously, but these new cases are concerning because of its resistance to being treated by existing drugs.

There have been cases where the fungal infection became resistant to drugs in patients who received treatment. The new cases were reported in the July 23 Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention (CDC).

“This is the first time that we’ve actually identified clusters with common health care exposures in the same facilities and among patients who had not received antifungals,” said Meghan Lyman, a medical officer in the mycotic diseases branch in CDC’s National Center for Emerging and Zoonotic Infectious Diseases, to STAT.

The new drug resistant cases were reported in Washington, D.C., and Texas between January and April 2021, according to the MMWR. Three isolates in D.C. and two in Texas were pan-resistant, meaning it was resistant to all three categories of antifungal drugs. Five cases in Texas were resistant to two categories of drugs.

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The health experts at the institutions tested for C. auris from skin samples of patients at health care facilities, including long-term care facilities.

“We tend to see transmission and see cases among patients who are in these high-acuity, long-term care facilities … that have very high-acuity, very sick patients like ones who are on ventilators or have tracheostomy or other invasive medical devices,” Lyman says. “Getting Covid and then having these complications put them at higher risk for acquiring Candida auris.”

Treatment options for C. auris are limited, and drug resistance has been a growing issue. If this evidence is what it seems, that could mean that the fungus can spread and patients may develop infections that are potentially untreatable.

“These cases are ones where the options are really limited. There are few treatment options for these patients who have clinical infections,” says Lyman. “And the fact that now it can spread, it’s not just in patients who are already getting treatment … means that a greater proportion of patients may have pan-resistance and [may] develop clinical infections that are potentially untreatable.”

The experts are concerned that these new cases are a sign that transmission of pan-resistant strains of C. auris is happening in hospitals and clinics where very ill patients are being treated.

“With all this spread that we’ve been seeing across the country we’re really encouraging health departments and facilities to be more proactive instead of reactive to identifying Candida auris in general,” says Lyman. “Because we’ve found that controlling the situation and containing spread is really easiest when it’s identified early before there’s widespread transmission.”

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