The week of August 14-18, 2017 has been declared Fungal Disease Awareness Week by the CDC. The theme of this year's awareness week is “Think Fungus,” and it aims to encourage the public and clinicians to consider the possibility of a fungal infection if a patient’s symptoms are not improving with treatment. Although the exact prevalence of fungal infections is difficult to quantify, the CDC has identified fungal pathogens to be an increasing problem worldwide.
What you need to know:
- In the United States, coccidioidomycosis or “Valley fever” occurs in approximately 10,000 cases each year, but more cases are likely undiagnosed. CDC estimates Valley Fever causes 150,000 infections annually.1
- Candida, a yeast that commonly causes mucosal and skin infections, is also an important cause of bloodstream infections in hospitalized patients. 1
- Antifungal resistance is a growing public health problem, particularly in Candidaand Aspergillus infections,* including the recent emerging threat of Candida auris, a multidrug-resistant yeast that appears to spread in healthcare facilities. 1
- Drug-resistant infections lead to longer hospital stays, higher medical costs, and more deaths. Globally, cryptococcal meningitis, histoplasmosis, and Pneumocystispneumonia remain important causes of death in patients with HIV infections and AIDS.1
One pathogen of particular concern lately is antimicrobial-resistant Candida auris, which can cause bloodstream infections and even death. In fact, the CDC reports that 1 in 3 patients with an invasive C. auris infection will die.3 Although still rare in the U.S., a total of 77 infections have been reported, and the pathogen is increasing in frequency and geographic distribution2. In June 2016 the CDC issued an alert on this emerging fungal pathogen.
Ryan W. Stevens, PharmD, BCPS, and William Barany, PharmD identify the following concerning C. auris characteristics in their August 15, 2017, article Candida Auris: The Rise of a New Fungal Threat2
- Acquisition appears to be largely health care-associated. In one report of 41 patients with auris, 73% had central venous catheters, 61% had urinary catheters, and 51% had undergone surgery in the prior 90 days.
- auris has high potential for patient-to-patient transmission. Among 390 close contacts of the first 77 infected patients in the U.S., 45 (12%) were found to be colonized with the organism.
- auris appears to survive on surfaces within an infected patient’s hospital environment. The organism has been isolated from beds, windowsills, chairs, infusion pumps, and other surfaces.
- This organism can be especially difficult to identify. The CDC recommends that all Candidaisolates obtained from a normally sterile site (e.g., bloodstream) be identified to the species level so that appropriate initial treatment can be administered.4
- One final characteristic that makes auris particularly concerning is its lack of susceptibility to commonly used antifungals. Early reports have demonstrated that C. auris isolates have high rates of multidrug resistance.3
While the direct goal of Fungal Awareness Week is to encourage healthcare providers and clinicians to consider the possibility of a fungal infection when patients are not responding to treatment, we would be remiss not to discuss what can be done to prevent this pathogen from spreading within the healthcare environment.
The CDC provides recommendations for C. auris infection control including increased emphasis on patient, visitor and healthcare worker hand hygiene. When caring for patients for C. auris, healthcare workers should follow standard and contact precautions, which include the following standard hand hygiene practices
- Practicing hand hygiene at all indications (WHO 5 Moments or Canada 4 Moments)
- Use of an alcohol-based hand sanitizer when hands are free of debris
- Washing with soap and water when hands are visibly soiled
- Remember that gloves are not a substitute for hand washing or hand sanitizing
As part of Contact Precautions, healthcare personnel should:
- Always wear gloves to reduce hand contamination.
- Avoid touching surfaces outside the immediate patient care environment while wearing gloves.
- Perform hand hygiene before donning gloves and following glove removal.
Visiting family members and other close contacts of patients with C. auris should:
- Clean their hands with hand sanitizer or soap and water before and after touching a patient with aurisor the equipment within his or her room.
- Remind healthcare workers to follow suit and clean their hands.
During Fungal Awareness Week, August 14-18, please #ThinkFungus. Awareness is one of the most important means to reduce delays in diagnosis and treatment, which can lead to better health outcomes and save lives.
1. Announcement: Fungal Disease Awareness Week — August 14–18, 2017. MMWR Morb Mortal Wkly Rep 2017;66:837. DOI: http://dx.doi.org/10.15585/mmwr.mm6631a6
2. http://www.contagionlive.com/publications/contagion/2017/august2017/candida-auris-the-rise-of-a-new-fungal-threat?3. https://www.cdc.gov/fungal/diseases/candidiasis/c-auris-drug-resistant.html