The Pennsylvania Department of Health is asking all health care providers to review the CDC guidelines for the identification, treatment and infection control of C. auris and report any suspect cases of C. auris to their local public health jurisdiction. Guidelines are available at https://www.cdc.gov/fungal/diseases/candidiasis/candida-auris.html.
Candida auris is an emerging fungus that presents a serious global health threat. Healthcare facilities in several countries have reported that C. auris has caused severe illness in hospitalized patients. Some strains of C. auris are resistant to all three major classes of antifungal drugs. This type of multidrug resistance has not been seen before in other species of Candida. Also of concern, C. auris can persist on surfaces in healthcare environments and spread between patients in healthcare facilities.
C. auris infections have occurred in states surrounding Pennsylvania, but there are not yet reports of C. auris infection acquired in Pennsylvania. Updated information on the national distribution of C. auris can be found at https://www.cdc.gov/fungal/diseases/candidiasis/candida-auris.html.
Additional general information about C. auris is available at https://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-qanda.html.
IDENTIFICATION
C. auris can be difficult to detect, as conventional biochemical identification has not been reliable. Unidentified Candida species or identification of rare Candida species may represent misidentification of C. auris.
CDC’s guidance provides detailed instruction for laboratories on when to suspect C. auris, (see https://www.cdc.gov/fungal/diseases/candidiasis/recommendations.html). A suspect case of C. auris should be reported to the Department as described below.
REPORTING
Any health care provider or laboratorian who suspects or identifies C. auris in a patient should notify their local health department or the Bureau of Epidemiology at 1-877-PA-HEALTH to arrange confirmatory identification of the organism through public health laboratories.
Additional public health response will be indicated to prevent and control the spread of this organism, particularly in health care settings.
TREATMENT
Multidrug resistance is common in C. auris. Most strains of C. auris found in the United States have been susceptible to echinocandins although echinocandin-resistant isolates have been reported. Patients on antifungal treatment should be carefully monitored for clinical improvement and follow-up cultures and repeat susceptibility testing should be conducted.
CDC has developed specific treatment guidelines for adults, infants, and neonates. These are available at https://www.cdc.gov/fungal/diseases/candidiasis/c-auris-treatment.html.
CDC does not recommend treatment of C. auris cultured from noninvasive sites when there is no evidence of infection.
INFECTION CONTROL
To prevent the transmission of C. auris in healthcare settings, the following should be implemented in inpatient settings (acute-care hospitals; long-term acute care hospitals; nursing homes):
- Place the patient with auris in a single-patient room and use Standard and Contact Precautions
- Emphasize adherence to hand hygiene.
- Clean and disinfect the patient care environment (daily and terminal cleaning) with an Environmental Protection Agency (EPA)-registered hospital-grade disinfectant effective against Clostridium difficile
- Screen contacts of infected patients to identify auris colonization. Please contact the local health department or the Bureau of Epidemiology at 1-877-PA-HEALTH for assistance with screening.
The CDC has developed infection control recommendations for inpatient settings, dialysis and infusion centers, outpatient settings, home healthcare settings, and for home and family members. Please see additional recommendations at https://www.cdc.gov/fungal/diseases/candidiasis/c-auris-infection-control.html.
Prevention of illness and control of the transmission of C. auris is dependent upon the coordination of efforts between the patient, facility, provider, and public health authority. The Department asks providers and laboratorians to report all suspect or confirmed cases of C. auris immediately so that broad public health response can be initiated in a timely manner. Please contact the local health department or the Bureau of Epidemiology at 1-877-PA-HEALTH to report suspected infections or with any questions.
Originally released by the Pennsylvania Department of Health on August 11, 2017.
