Another reason to avoid hospitals…
By the normal standards of outbreak, Candida auris signals a mind-bending shift’and it’s forcing researchers draw on some of medicine’s oldest practices.
A pathogen that resists almost all of the drugs developed to treat or kill it is moving rapidly across the world, and public health experts are stymied how to stop it.
By now, that’s a familiar scenario, the central narrative in the emergence of antibiotic-resistant bacteria. But this particular pathogen isn’t a bacterium. It’s a yeast, a new variety of an organism so common that it’s used as one of the basic tools of lab science, transformed into an infection so disturbing that one lead researcher called it “more infectious than Ebola” at an international conference last week.
The name of the yeast is Candida auris. It’s been on the radar of epidemiologists only since 2009, but it’s grown into a potent microbial threat, found in 27 countries thus far. Science can’t yet say where it came from or how to control its spread, and hospitals are being forced back into old hygiene practices — putting patients into isolation, swabbing rooms with bleach — to try to control it.
“This bug is the most difficult we’ve ever seen,” says Dr. Tom Chiller, the chief of mycotic diseases at the CDC, who made the Ebola remark at the 20th Congress of the International Society for Human and Animal Mycology in Amsterdam. “It’s much harder to kill.”
Now there have been 340 cases recorded in the US, in 11 states — and the behavior of the bug in this country is teaching microbiologists more about how the new yeast behaves. It seems that not every continent develops its own strain. Instead, the U.S. is playing host to several micro-epidemics, each of which was sparked by one or several travelers from somewhere else. Cases found in New York, New Jersey, Oklahoma, Connecticut, and Maryland bear the genetic pattern of South Asia. Illinois, Massachusetts, and Florida’s cases show South America’s genetic pattern. And randomly, the few cases recorded in Indiana seem to be linked to a South African strain.
Wherever they come from, the subtle variants of C. auris share an important characteristic: They are highly drug resistant.
There aren’t many bright spots in the looming battle against C. auris. One may be this: Most of the patients so far, and all of those who have died, have been people who were hospitalized because they were already somehow ill — with diabetes, cardiovascular disease, cancers, and other illnesses. They were on ventilators, threaded with IVs and catheters, and receiving multiple drugs that undermined their immune systems’ competence. In other words, the disability community…..
That means there’s a limited population who may be at risk, which also means there’s a limited group for whom the most costly protections should be necessary. But patients that ill are often cared for, not in hospitals, but in nursing homes and skilled nursing facilities — and those institutions tend not to hire or empower the sharp-eyed infection-prevention practitioners that hospitals do. So that raises the question of how to detect the yeast in a patient before that person enters an institution.
