CDC study shows uptick in C. auris infections in recent years

Cases and transmission of Candida auris have continued to rise since the multidrug-resistant fungus was first reported in the U.S. in 2016. Reports of cases to the CDC rose by 44% in 2019 and 95% in 2021.

Candida auris cases and transmission continued to rise in recent years in the U.S., including in areas with no prior cases, a recent study found.

The emerging fungus was first reported in the U.S. in 2016. CDC researchers used national surveillance data to describe recent changes in the epidemiology of C. auris occurring from 2019 to 2021. They aggregated case counts reported to the CDC by health departments, as well as data on colonization screening and antifungal susceptibility results, and compared them over time and by geographic region. Results were published March 21 by Annals of Internal Medicine.

A total of 3,270 clinical cases and 7,413 screening cases of C. auris were reported in the U.S. through the end of 2021. The percentage increase in clinical cases grew each year, from a 44% increase in 2019 to a 95% increase in 2021. In 2021, colonization screening volume increased by more than 80% and screening cases increased by more than 200%. Throughout the study period, 17 states identified their first C. auris case. The number of cases that were resistant to echinocandins in 2021 was about three times that in the previous two years. As in previous years, most cases were found in high-acuity post-acute care facilities, especially long-term acute care hospitals (LTACHs), although several large C. auris outbreaks have occurred in acute care hospitals in recent years.

While C. auris was not a reportable condition in many jurisdictions and screening cases were not nationally notifiable, case reporting seemed to be minimally affected, the authors noted. They added that screening varies across the U.S. and that the data used do not reflect the full extent of C. auris susceptibility or colonization testing performed nationally.

In addition to surveillance, screening, and infection control, new tools are needed to combat C. auris, including faster and more accessible colonization testing, improved disinfection methods, increased capacity for antifungal susceptibility testing, and new antifungal drugs, the authors noted. “Targeting interventions to the weakest links in the health care system's infection control network, specifically LTACHs and ventilator-capable skilled-nursing facilities, will have benefits beyond C auris, including reducing the spread of other [multidrug-resistant organisms] and improving preparedness for future epidemics,” they wrote. “The spread of C auris provides motivation to refocus on public health fundamentals to prevent illness and save lives.”

For more on C. auris, ACP members can read ACP Hospitalist's March 2017 story outlining five things clinicians should know about the multidrug-resistant fungus (single sign-on required).