Candida Auris Cases in U.S.
It wasn’t publicized locally, but within the past few years teams of health officials at two Oklahoma health facilities took rapid actions to contain the spread of a fungal “superbug” that federal officials have declared a serious global health threat.
Only one patient at each facility was infected, and both patients recovered. But the incidents reflect the growing alarm among health officials over the deadly, multidrug-resistant Candida auris, or C. auris, which can kill 30 percent to 60 percent of those infected.
Oklahoma is one of 12 states that had reported confirmed cases of the fungus by late February. By comparison, Texas reported one and California two. The problem is much more severe in New York, with 309 confirmed cases, and Illinois, with 144.
In April 2017, a team of experts from the federal Centers for Disease Control and Prevention converged on the University of Oklahoma Medical Center in Oklahoma City after a patient tested positive for the drug-resistant fungus.
About a year later, a patient at a southeast Oklahoma health facility tested positive for the germ during a routine test. In both cases, health officials isolated the patients, locked down their rooms and ordered dozens of lab tests to see if the multidrug-resistant fungus had spread.
Number of C. Auris Cases, by StateNearly 600 cases of Candida auris had been confirmed in 12 states as of Feb. 28, 2019, according to the U.S. Centers for Disease Control and Prevention. Targeted screening in seven of the states also found 1,046 additional patients who had been colonized with the fungus.
Unlike with outbreaks in Illinois, New York and New Jersey, the potentially deadly infection was quickly contained.
But the two cases highlight the risks of C. auris, a germ that worried the CDC enough to issue a clinical alert in 2016 for all U.S. health care facilities to be on the lookout for suspected cases. State and local health officials say its emergence in Oklahoma is a reminder that hospitals, health clinics and even nursing homes need to be aware of the emerging threat.
“It’s hard to speculate on what we may or may not see in the future,” said Interim State Epidemiologist Laurence Burnsed. “But the important thing is to be aware of the challenges trying to limit transmission and risk.”
An Emerging Threat
First discovered in Japan in 2009, C. auris has spread to more than 30 countries, including the United States.
In a 2017 update to its clinical alert, the CDC notified health facilities that a number of patients who tested positive with the fungus were hospitalized after trips abroad, including to India, Pakistan, South Africa and Venezuela.
But the agency also noted that those who haven’t traveled abroad are also at risk because the yeast can spread from person to person, colonize patients’ skin and survive on door handles, tray tables and other surfaces for months.
The fungus can then enter the bloodstream and cause potentially fatal infections. Statistics show it sometimes kills half of those who get it, although they typically are frail or have compromised immune systems. Elderly patients in long-term nursing centers, particularly those with a catheter, have increased risk.
The CDC warns that many disinfectants commonly used in the health care industry are ineffective in stopping the fungus. Some strains are resistant to all three main classes of antifungal drugs.
Containing the Threat
Due to privacy concerns, the Oklahoma State Department of Health would not disclose where the state’s two reported cases took place, except to say one occurred in Oklahoma County and the other in southeast Oklahoma.
“I hesitate to go into any more details because with the time and place, it could lead to identifying the patients,” Burnsed said.
But published documents, including a PowerPoint presentation and article on the CDC’s website, suggest the April 2017 case occurred at the OU Medical Center. The hospital confirmed the case in a statement to Oklahoma Watch.
The documents paint the seriousness of the situation by describing how a three-person team from the CDC, including an expert in fungal infections, helped state and local health officials take 73 samples, including tray tables and door handles, and send them to CDC labs over a two-day period.
Hospital officials also reviewed about a year of previously taken samples to rule out the possibility that the patient caught the germ in the hospital.
The digital presentation from the hospital’s infection control manager notes that hospital officials didn’t find anything outside of the patient’s room and believe it came from outside the hospital.
OU Medicine Chief Quality Officer Dr. Dale Bratzler said the patient acquired the infection in Asia and was already in isolation due to multiple infections from drug-resistant organisms when C. auris was identified.
“The most important part of our strategy at OU Medicine for this type of infection is early detection,” he said. “Our laboratory is able to quickly identify this organism if we should ever see another patient with it.”
During the April incident, the CDC also worked with hospital staff to go over its infection containment strategy and review how to conduct environmental sampling so future tests can be done on site.
“The work in Oklahoma was deemed successful because CDC did not find further evidence of transmission,” CDC epidemiologist Karlyn Beer Beer said in the CDC article. “This is a testament to the quality of the hospital’s lab surveillance, infection control and its commitment to finding and preventing C. auris transmission.”
When to Disclose
Public knowledge about the OU Medical Center case makes it an exception. Typically, health care facilities across the nation don’t release to the public information when C. auris and other drug-resistant pathogens are found. No law or policy requires them to do so.
Patient-rights advocates maintain that the public has the right to know when and where outbreaks or even single cases occur. But health officials have routinely fought back, suggesting that it could violate patient rights and discourage patients from seeking hospital care.
But the CDC allows states to make that decision.
Burnsed said the Department of Health tries to walk a tight line between notifying the public and protecting the patient’s privacy.
He said he would be more likely to identify a facility if it’s anything more than an isolated case or if officials believed the exposure wasn’t contained.
“What we consider is if there was a risk to a broader group of individuals and if there was any evidence that there were a breach in lab controls,” Burnsed said. “We didn’t put out anything at the time (on Oklahoma’s two cases) because we didn’t think there was a greater risk to the public, but it’s a good question to consider.”