Tale of Two Bugs: Has Candida auris taken advantage of SARS-CoV-2’s afflicted? Part 2

Author: Holly Montejano, MS, CIC, CPHQ, VA-BC

Categories: Clinical Pathogens/Alerts December 8, 2020
candida auris

Candida auris (c. auris) appears to be taking advantage of hospitalized patients during the pandemic. As with all MDROs, colonization can quickly become infection when host immunity is compromised and/or invasive devices create an easy entry portal.

C. auris thrives in the healthcare environment as it successfully attaches to sheets, bedrails, doors, and medical devices- making it easy to colonize the skin of hospitalized patients- and transmit within the facility1. C. auris grows optimally at 37-42° Celsius (98.6-107.6°F) 2, making the human body an ideal growth site. Hospitalized COVID-19 patients often need intensive care and may require the placement of catheters (urinary, peripheral/central venous, feeding and ventilator tubing).

The catheter tubing is a prime surface for C. auris to take up residence, providing optimal entry into the body to cause infection.  Chowdhary, et al reported that 50% of C. auris patients required ventilation because of severe COVID-19 pneumonia, and all patients with candidemia had indwelling central lines and urinary catheters3.  This same study also found that C. auris infections were probably hospital acquired, with patients having prolonged ICU stays, as well as underlying chronic conditions.3   Interestingly, Zuo, et al reported the fecal fungal microbiome of COVID-19 patients shows an increasing prevalence for opportunistic fungal pathogens, including C. albicans, C. auris and Aspergillus flavis4.  This could also impact C. auris colonization and infection rates, as well as transmission, within those hospitalized during the pandemic.

In 2020, there has been a 400% increase in confirmed cases of C. auris (compared to case numbers in 2018, the most recent year with data available).1 It would be safe to assume that cases may be much higher, as colonization often exists without infection, and the current pandemic has impeded C. auris surveillance efforts.  To a certain degree, this could also be the natural progression of spread of the multi-drug resistant organism.  As laboratory identification can be difficult and the use of anti-fungal therapies aren’t always tracked within stewardship programs, both could be helping drive the prevalence of this organism.

With COVID-19 cases surging now in the fall and winter months, the importance of testing and contact tracing will be critical to control the spread of newly emerging and often difficult to treat organisms1As Borman, et al concluded, overwhelmed intensive care units (ICUs), breakdown of infection prevention measures, and high-risk patients requiring mechanical ventilation and other invasive supportive care due to the COVID-19 pandemic, appear to provide ideal conditions for outbreaks of C. auris5.

It will remain imperative that basic infection prevention measures are maintained to curtail the spread of all MDROs during this pandemic: PPE compliance (where resources allow as PPE availability is limited), hand hygiene products, like PDI Sani-Hands® wipes, environmental cleaning and disinfection (See EPA List N for SARS-CoV-2 approved products), as well as  isolation precautions, appropriate use of antimicrobials, and continued surveillance of MDROs and antimicrobial resistance.

References

  1. National Geographic Science- Coronavirus Coverage: Drug-resistant superbug thriving in hospitals hit hard by COVID-19. https://www.nationalgeographic.com/science/2020/10/drug-resistant-superbug-candida-auris-thriving-hospitals-coronavirus-era/  Accessed 11/4/2020.
  2. Centers for Disease Control and Prevention. Candida auris. https://www.cdc.gov/fungal/candida-auris/. Accessed 11/18/2020.
  3. Chowdhary, Anuradha, et al. “Multidrug-resistant Candida auris infections in critically Ill coronavirus disease patients, India, April–July 2020.” Emerging Infectious Diseases11 (2020): 2694.
  4. Zuo, Tao, et al. “Alterations in fecal fungal microbiome of patients with COVID-19 during time of hospitalization until discharge.” Gastroenterology4 (2020): 1302-1310.
  5. Borman, Andrew M., and Elizabeth M. Johnson. “Candida auris in the UK: Introduction, dissemination, and control.” PLoS Pathogens7 (2020): e1008563.

Author

Holly Montejano MS, CIC, CPHQ, VA-BC
holly Clinical Science Liaison, PDI Gulf Coast

Profile

Holly’s passion for infectious disease epidemiology developed during her undergraduate studies at University of Connecticut, where she studied biology and anthropology – and the profound impact of disease on people, public health and within healthcare systems. This passion led to a graduate program focused in infectious disease epidemiology and a post-graduate epidemic intelligence service (EIS) fellowship in public health, and a graduate certification in infection control at the University of South Florida.

After several years as a public health epidemiologist, Holly transitioned into infection prevention and healthcare epidemiology where she currently is part of a dynamic clinical affairs team, supporting the Gulf Coast region as a Clinical Science Liaison (CSL).

Contact

Phone: 321.439.7923

Company Website: Pdihc.com

Email: Holly.Montejano@pdihc.com

Hobbies

Interior design
Beach staycations
Little League baseball and softball

Education

University of Connecticut, Storrs, CT
Bachelor of Science in Biology and Anthropology

Colorado State University, Fort Collins, CO
Master of Science in Environmental and Radiological Health Sciences (Epidemiology and Infectious Disease)

Certification
Certification Board of Infection Control (CBIC)- CIC
Certified Professional in Healthcare Quality (NAHQ)- CPHQ
Vascular Access- Board Certified (VA-BC)
Lean Six Sigma Yellow Belt Certification
Prosci Change Management Certification

Why I love what I do

Infectious disease epidemiology – from both a biological and anthropological standpoint – have always been a passion of mine. Studying the effects of disease on populations (from a public health standpoint and from that of an Infection Preventionist) has fueled my interest in patient safety and quality outcomes initiatives. My work of providing clinical expertise and evidence-based guidance on infection prevention products (which are used in communities and healthcare systems daily) bolsters the satisfaction I experience in this role.

Areas of Expertise

Microbiology and infectious disease transmission
Infection Prevention
Patient Safety and healthcare quality
Safety culture
Public Health
Vascular access
Environmental disinfection
Performance Improvement
Education

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