POST 142. March 15, 2021. CORONAVIRUS. “Candida auris is a superbug, a pathogen that can evade drugs made to kill it—and early signs suggest the COVID-19 pandemic may be propelling infections of the highly dangerous yeast. That’s because C. auris is particularly prominent in hospital settings, which have been flooded with people this year due to the coronavirus.”

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POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018

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Over Christmas break in 2015, Johanna Rhodes received a panicked email from a doctor working at the Royal Brompton Hospital, the largest heart and lung center in the United Kingdom. A horrid yeast was invading the skin of patients, spreading through the intensive care unit even though the hospital maintained extensive protocols for infection control.

“The doctor asked me to take a look … I thought, how bad can it be?” recalls Rhodes, an infectious disease expert at Imperial College London who studies antifungal resistance. Rhodes stepped in to help one of the world’s top cardiology hospitals identify the pathogen and clear it from the premises. The germ was Candida auris, little known at the time. What she saw stunned her: “You think COVID-19 is bad until you see Candida auris.”

Candida auris is a superbug, a pathogen that can evade drugs made to kill it—and early signs suggest the COVID-19 pandemic may be propelling infections of the highly dangerous yeast. That’s because C. auris is particularly prominent in hospital settings, which have been flooded with people this year due to the coronavirus.

The superbug sticks stubbornly to surfaces such as sheets, bed railings, doors, and medical devices—making it easier to colonize skin and pass from one person to another. Moreover patients who have tubes that go into their body, such as catheters or ones for breathing or feeding, are at the highest risk for C. auris infections, and these invasive procedures have become more common because of the respiratory failure associated with COVID-19…

The worry is that if C. auris becomes more common in hospitals or the general public, it could bolster the growing crisis of superbugs, which already infect millions worldwide. Last year, the CDC classified C. auris as one of the biggest drug resistance threats in America. Now, though it’s too early to confirm a direct knock-on effect, the U.S. has recorded 1,272 confirmed cases of C. auris in 2020, a 400 percent increase over the total recorded during all of 2018, the most recent year with available data.

The real number is likely to be much higher, though, as the COVID-19 pandemic has halted much of the disease surveillance for C. auris at hospitals and because the germ can often colonize a person’s skin without generating symptoms.

Such superbugs may also be contributing to the tens of thousands of excess deaths occurring during the COVID-19 era. Hence why doctors around the world are sounding the alarm.” (A)

“Health systems have had to adapt their operations to meet the urgent needs of the COVID-19 pandemic, but experts warn that pathogens like Candida auris are taking advantage of gaps in monitoring and containment efforts, and COVID-19 patients are at risk for fatal coinfection.

“Most health care facilities have been extremely stressed for resources and personnel during the pandemic, which may create ideal conditions for nosocomial outbreaks with pathogens such as C. auris,” said Melissa Johnson, PharmD, an associate professor of medicine, Division of Infectious Diseases and International Health, at Duke University Medical Center, in Durham, N.C.

 At the CDC’s last count on Nov. 30, 2020, there were 1,595 confirmed clinical cases of C. auris reported in the United States—an increase of more than 400% over 2018, which is the most recent year with available data. Rising C. auris infection rates make coinfection with SARS-CoV-2 increasingly likely, recent data indicated.

According to a report this year in Morbidity and Mortality Weekly Report (2021;70[2];56-57), a Florida hospital reported three C. auris infections in four patients with SARS-CoV-2, who were hospitalized in the same COVID-19 unit in July 2020. The acute care hospital’s COVID-19 unit took up five wings on four floors, each with ICU rooms…

“The crowding in our ICUs and the need in some places to provide intensive care in hospital units not designed for this purpose, sometimes staffed by health care workers not completely prepared to provide this level of care, augurs a repeat of this Indian experience in the U.S.,” Stephen Baum, MD, a professor of medicine and of microbiology and immunology at Albert Einstein College of Medicine, in New York City, cautioned in an online commentary on the Indian study.

Indeed, the California Department of Public Health issued a health advisory based on sharp increases in C. auris cases in health care facilities in that state after the numbers nearly doubled.

“Personal protective equipment conservation strategies and other containment strategies (e.g., cohorting) on the basis of COVID-19 status alone might be contributing to this resurgence of C. auris,” the agency stated on its website.

Hospitals need to “continue with routine screening and infection control practices despite having the increased workload of dealing with COVID-19,” said Susan Poutanen, MD, MPH, a medical microbiologist and an infectious disease physician at the University Health Network and Sinai Health, and an associate professor, Departments of Laboratory Medicine and Pathobiology and Medicine at the University of Toronto.

The reports of “nosocomial C. auris transmission in patients with COVID-19 admitted to the ICU is an excellent reminder of the need for such efforts,” Poutanen said.

Despite their best intentions, some hospitals experienced interruptions in their C. auris screening programs during the pandemic, she noted.” (B)

“The yeast infection may have been caused due to the reuse of the personal protective equipment (PPE), as per a report by the Centers for Disease Control and Prevention (CDC)…

The recent outbreak began in July when a hospital, which the report did not name, notified the Florida Department of Health of an initial four cases of the fungus among patients being treated for the coronavirus.

The next month, the hospital carried out additional screening in its Covid-19 unit, which spanned four floors across five wings, and identified 35 more patients as being Candida Auris-positive.

Follow-up data was available for only 20 out of the 35 patients. Eight of these 20 people died, but it was not clear whether the fungus was the main factor or not.

The Florida Department of Health and CDC performed a joint investigation focused on infection prevention and control measures, finding numerous weaknesses.

“Mobile computers and medical equipment were not always disinfected between uses, medical supplies (e.g., oxygen tubing and gauze) were stored in open bins,” the CDC report said.

It added that hospital staff, possibly out of fear of the coronavirus, were wearing multiple layers of personal protective equipment (PPE), which is not recommended and in fact heightens the risk of microbe transmission.

There were also instances of extended PPE use and re-use.

After the hospital removed supplies from hallways, enhanced cleaning and disinfection practices, and improved practices around PPE use, no further Candida Auris was detected on subsequent surveys.

“Outbreaks such as that described in this report highlight the importance of adhering to recommended infection control and PPE practices and continuing surveillance for novel pathogens like Candida Auris,” the report concluded.

Candida Auris has now been documented in more than 30 countries, with some 1,500 US cases reported to the CDC as of October 31, 2020.

The CDC says the fungus can spread in healthcare settings “through contact with contaminated environmental surfaces or equipment, or from person to person.” (C)

“The recent outbreak of the fungal infection was reported in July 2020. the Florida Department of Health reported the initial four cases of the fungus, among patients being treated for COVID-19, the disease caused by the novel coronavirus.

The following month, they carried out additional screening and identified 35 more patients were already infected with the fungus.

Eight of 20 people, whose follow-up data were available, died. However, it was not certain if the fungus was the main factor or not.

The Florida Department of Health and CDC performed a joint investigation focused on infection prevention and control measures, finding numerous weaknesses.

“Mobile computers and medical equipment were not always disinfected between uses, medical supplies (e.g., oxygen tubing and gauze) were stored in open bins,” the CDC report said.

It added that hospital staff, possibly out of fear of the coronavirus, were wearing multiple layers of personal protective equipment (PPE), which is not recommended and in fact heightens the risk of microbe transmission.

There were also instances of extended PPE use and re-use, Wion News reported.

After the hospital removed supplies from hallways, enhanced cleaning and disinfection practices, and improved practices around PPE use, no further Candida Auris was detected on subsequent surveys.

“Outbreaks such as that described in this report highlight the importance of adhering to recommended infection control and PPE practices and continuing surveillance for novel pathogens like Candida Auris,” the report concluded.

Candida Auris has now been documented in more than 30 countries, with some 1,500 US cases reported to the CDC as of October 31, 2020.

The CDC says the fungus can spread in healthcare settings “through contact with contaminated environmental surfaces or equipment, or from person to person.” (D)

“The California Department of Public Health (CDPH) has released a Health Advisory alerting providers of the increasing number of Candida auris (C. auris) cases reported in Southern California in recent months.

CDPH notes that personal protective equipment conservation strategies and cohorting COVID-19 patients might be contributing to this resurgence of C. auris. As a result, CDPH recommends health care facilities:

Assess C. auris and other multidrug-resistant organism (MDRO) status for all patients and residents upon admission, by reviewing medical records and screening high-risk individuals.

When cohorting patients by COVID-19 status, consider C. auris and other MDRO status during room placement.

Do not reuse or extend use of gloves or gowns between patients with different or unknown C. auris or other MDRO, and COVID-19 status.

CDPH also advises health care facilities to report any cases of C. auris or unusual or highly-resistant organisms to their local health department and CDPH at [email protected].

CDPH also advises health care facilities to report any cases of C. auris or unusual or highly-resistant organisms to their local health department and CDPH at [email protected].” (E)

“Whenever a facility has a suspected or confirmed case of C. auris, rapid action is the name of the game. Nursing and infection prevention teams need to be notified swiftly, so that they in turn can immediately implement appropriate infection prevention protocols, stressed Teri Caughlin, RN, MHA, regional director of infection prevention for Southern California Kaiser Permanente in Pasadena. These protocols typically include contact precautions, personal protective equipment (PPE), and Environmental Protection Agency-approved surface cleaning products effective against C. auris. The latter matters because even products with fungicidal claims might not kill C. auris.

Establishing point prevalence and conducting contact tracing and admission screening also are essential elements for controlling the spread of C. auris, added Sudha Chaturvedi, PhD, director of the Mycology Laboratory at the New York State Department of Health’s Wadsworth Center in Albany. All of these strategies depend on the availability of swift and accurate testing, she stressed.

Although some hospitals in high prevalence areas might routinely test all patients for C. auris colonization, others might not do so until they have a positive case. This type of epidemiologic search is critical, said Procop: “The clinical isolate may be the tip of the proverbial iceberg.”

Some evidence suggests that the COVID-19 pandemic could exacerbate C. auris transmission in healthcare facilities. PPE shortages, or changes in infection control practices spurred by concerns about future shortages, could allow the fungus to spread. “This has been observed in long-term care facilities, as well as acute care hospitals, which typically had less C. auris transmission prior to the COVID-19 pandemic,” said Meghan Lyman, MD, epidemiologist at CDC.

Facilities also can’t take for granted that the same procedures that curb the spread of SARS-CoV-2 will work for C. auris. For example, “disinfectants recommended for use against COVID-19 in the United States are either ineffective against C. auris or have not yet been tested for effectiveness,” warned Berkow.

However, improved hand hygiene due to the COVID-19 pandemic has benefited patients by reducing the transmission of non-COVID pathogens, said Caughlin. And the COVID-19 pandemic might not have compromised the ability to detect C. auris in facilities like Van Horn’s with dedicated mycology labs, he suggested.

“We will have a clearer picture of what, if any, impact the COVID-19 pandemic has had on C. auris control later in the year,” added Chaturvedi.” (F)

“Seeing the world as a one-pathogen world is really problematic,” said Dr. Susan S. Huang, an infectious disease specialist at the University of California at Irvine Medical School, noting that the nearly singular focus on the pandemic appears to have led to more spread of drug-resistant infection. “We have every reason to believe the problem has gotten worse.”…

In an acknowledgment of the issue, three major medical societies sent a letter on Dec. 28 to the Centers for Medicare and Medicaid Services asking for a temporary suspension of rules that tie reimbursement rates to hospital-acquired infections. The three groups — the Society of Healthcare Epidemiology of America, the Society of Infectious Diseases Pharmacists, and the Association for Infection Control and Epidemiology — feared that the infection rates may have risen because of Covid-19.

“Patient care staffing, supplies, care sites and standard practices have all changed during this extraordinary time,” the letter stated.

Not all types of drug-resistant infections have risen. For instance, some research shows no particular change during the pandemic in the rate of hospital patients acquiring the bacterium Clostridioides difficile — a finding that suggests the overall long-term impact of the pandemic on these infections is not yet clear.

Dr. Huang and other experts said they are not suggesting that the priority on fighting Covid-19 was misplaced. Rather, they say that renewed attention must be paid to drug-resistant germs. Earlier research has shown that as many as 65 percent of residents of nursing homes carry some form of drug-resistant infection.

Over the years, critics have charged that hospitals and, in particular, nursing homes, have been lax in their efforts to confront these infections because it is expensive to disinfect equipment, train staff, isolate infected patients and screen for the germs.

In response to these and other concerns, a greater effort was beginning to be made before the pandemic to monitor patients for these infections, particularly as they cycled in and out of nursing homes and intensive care units. This revolving door is known to spread germs that are carried by infected patients.

But after the pandemic began, there was much less monitoring and even, at times, a wholesale breakdown of communications about the transfer of such patients, experts said. Plus, the sickest Covid-19 patients were put on ventilators, where drug-resistant infections can cling and then spread.

Another possible contributor has been the heavy and regular use of steroids to treat Covid-19. These drugs help alleviate the virus’s most dangerous symptoms but can leave the immune system compromised in a way that allows other germs to more easily infiltrate the body.

The combination of these factors “is perfect” for the fungus to “take hold,” said Dr. Tom Chiller, the head of the fungal division of the C.D.C….

The upshot is that the confirmed cases are “likely the tip of the iceberg,” Dr. Chiller said.” (G)

• A.Drug-resistant superbug thriving in hospitals hit hard by COVID-19, BY SOPHIE COUSINS, https://www.nationalgeographic.com/science/article/drug-resistant-superbug-candida-auris-thriving-hospitals-coronavirus-era
• B.C. auris Taking Advantage of Focus on COVID-19, By David Wild, https://www.pharmacypracticenews.com/Covid-19/Article/03-21/-em-C-auris-em-Taking-Advantage-of-Focus-on-COVID-19/62809
• C.Candida auris: Killer fungus spreading rapidly in coronavirus wards in US, https://www.wionews.com/world/candida-auris-killer-fungus-spreading-rapidly-in-coronavirus-wards-in-us-355544
• D.Candida Auris: All you need to know about the deadly fungus that plagued COVID wards in the USHealth, by Anushree Gupta, https://www.timesnownews.com/health/article/candida-auris-all-you-need-to-know-about-the-deadly-fungus-that-plagued-covid-wards-in-the-us/705286
• E.Candida auris Cases Related to COVID-19 Surge in Health Care Facilities, by KIYOMI BURCHILL, https://www.calhospital.org/cha-news-article/candida-auris-cases-related-covid-19-surge-health-care-facilities
• F.Institutions explore the best options for identifying and mitigating C. Auris, by Kristin Harper,https://www.aacc.org/cln/articles/2020/october/stopping-superbug
• G.With All Eyes on Covid-19, Drug-Resistant Infections Crept In, By Matt Richtel, https://www.nytimes.com/2021/01/27/health/covid-drug-resistant-infections.html?referringSource=articleShare