Candida auris, also referred to as C. auris, is a potentially deadly fungal infection that appears to be making its way through hospitals and long-term care facilities across the country. The New York City area and New Jersey have reported more than 400 cases over the last few years alone. Federal health authorities have declared this fungus a “serious global health threat.”
C. auris is a particularly concerning fungus because it is resistant to some or all anti-fungal medicines, and can live on surfaces for days. This makes the fungus particularly hard to both treat and eradicate, as it can quickly lead to death in patients who have already weakened immune systems or are otherwise already compromised with serious medical problems.
For decades, public health experts have been warning hospitals and doctors that the overuse of antibiotics would reduce the effectiveness of the drugs. Unfortunately, C. auris appears to be an inevitable result of the over-prescription of antimicrobial drugs to combat bacteria and fungi.
According to the Centers for Disease Control and Prevention (CDC), the fungus is so concerning that it has been declared a serious global health threat following the discovery of these infections. Officials believe that people who have stayed in a hospital for an extended period of time or had a catheter or other intravenous tube inserted into them are at risk of infection. Those who would have previously received antibiotics or antifungal medications are also at risk.
The CDC first asked health facilities to begin reporting infections of C. auris in June 2016. Currently, New York has confirmed 309 cases over the past several years, some of which predate the agency’s first request.
The federal agency expressed concern about C. auris specifically because it is difficult to identify with standard laboratory methods, is resistant to a majority of antifungal treatments, and can easily spread across a number of medical settings, such as hospitals and care homes.
The CDC also warned that it can be difficult to spot a C. auris infection, as the symptoms most commonly present as fever and chills, which do not improve after treatment for bacterial infection. These symptoms are associated with many other infections, which makes it that much harder to identify when most people who contract C. auris are already sick from other preexisting medical conditions.
People in normal good health are unlikely to present symptoms if they catch the fungus, but are still capable of carrying and then infecting others who have weaker immune systems. Currently, the CDC’s record of patients only includes those who have contracted C. auris and are presenting symptoms, so the number of those individuals who are carrying the fungus but not presenting symptoms is likely much higher.
Troublingly, New Jersey is among the states worst affected by the recently identified fungus. By the end of February, there were 132 confirmed and 22 probable cases of people infected by C. auris, which was a sharp increase from the handful of cases that were first identified in the state approximately two years ago.
CDC investigators initially believed the fungus had started in Asia and spread across the world, but with further research have since discovered that there are four distinctive versions of C. auris. These strains’ differences are so significant that researchers theorize that they diverged thousands of years ago and emerged as resistant pathogens in four different locations almost simultaneously.
In all, the U.S. has had 617 confirmed cases of C. auris infections, centered primarily around the New York City area, the Chicago area, and New Jersey. The CDC believes that more than one in three patients with an invasive infection of the fungus have died.
Even with what we know about the fungus, much still remains to be learned about it and how it spreads. Unlike other fungal pathogens which die shortly after leaving the body, C. auris persists for days. Further, it is currently unclear how common the fungus is in nursing homes, and what happens when patients go back and forth between the facilities and hospitals.
According to officials, the best defense against spreading the fungus is rigorous handwashing, and disinfecting hospital rooms and equipment that have come into contact with a patient.
Some disinfectants commonly used in hospitals have so far proved ineffective at removing the fungus from surfaces, making it harder to completely eradicate in a room or even building. At the Mount Sinai Hospital in New York, C. auris was found to be so invasive that the hospital needed special cleaning equipment and even had to rip out some of the ceiling and floor tiles to eradicate it.
This isn’t the first time New Jersey medical facilities have been under scrutiny for infection outbreaks. In September of last year, 11 children died and over two dozen others were infected with an adenovirus at a nursing and rehabilitation facility in Wanaque. Not long after, several other facilities in the state were discovered to also have the adenovirus outbreak.
At the moment, the New Jersey Hospitals Association has called on the medical profession to reduce the use of antibiotics so there’s less opportunity for drug-resistant organisms like C. auris to develop.
For decades, many public health experts have been sounding the alarm that the overuse of antibiotics would reduce the effectiveness of drugs that had historically lengthened lifespans by curing bacterial infections that had once been fatal. Scientists believe that unless more effective new medicines are developed, and the over-prescription of antibiotics is curbed, the risk of these super resistant fungi will eventually spread to otherwise healthier populations.
The medical malpractice team at the authors’ law firm has handled many cases where patients have suffered due to an outbreak or infection at a hospital or other care facility. If you or a loved one were injured due to a facility’s error or neglect, it is strongly recommended that you seek experienced counsel immediately.
Mike Ksiazek and Jeff Krawitz are shareholders with Stark & Stark in Yardley, Pennsylvania. They are members of the firm’s Accident & Personal Injury Group.