As a drug-resistant fungal disease, Candida auris, adapts to the warmer climate, cases of it rise; up 214% in Kentucky in 2022

Cases of a potentially fatal fungal disease called Candida auris have increased by 1,200 percent since 2017 and the warmer climate could be to blame, Camille Fassett reports for The Associated Press and Grist.

All of Kentucky's 29 clinical cases of C. auris were reported in 2021 and 2022. However, there was a 214% increase between the years, with seven in 2021 and 22 in 2022, according to the Centers for Disease Control and Prevention. 

Fungal disease expert Arturo Casadevall, a microbiologist, immunologist and professor at Johns Hopkins University, told Fassett that humans normally have tremendous protection against fungal infections because of our temperature. 

“However, if the world is getting warmer and the fungi begin to adapt to higher temperatures as well, some … are going to reach what I call the ‘temperature barrier’,” he said, referring to the threshold at which mammals’ warm bodies usually protect them from infection.

In other words, Fassett writes, "Over time, humans may lose resistance to these climate-adapting fungi and become more vulnerable to infections. Some researchers think this is what is happening with C. auris." 

And while C. auris is not usually dangerous for healthy people, it can be for older patients, people with pre-existing medical conditions and people in health-care settings. The death rate is estimated to be between 30% and 60%, according to the CDC. 

The pathogen was first identified 14 years ago in Japan and early on most cases in the U.S. were linked to people who had traveled from other places, Meghan Marie Lyman, an epidemiologist for mycotic diseases at the CDC, told Fassett. Now, she said, most cases are acquired locally, generally spreading among patients in health-care settings.

"In the U.S., there were 2,377 confirmed clinical cases diagnosed last year," Fassett reports. She adds, "In the U.S., the most cases last year were found in Nevada and California, but the fungus was identified clinically in patients in 29 states. New York remains a major hot hotspot."

Dr. Luis Ostrosky, a professor of infectious diseases at McGovern Medical School at UTHealth Houston, told Fassett that he thinks C. auris is “kind of our nightmare scenario.”

“It’s a potentially multidrug-resistant pathogen with the ability to spread very efficiently in health care settings,” he said. “We’ve never had a pathogen like this in the fungal-infection area.”

The problem is so bad that the CDC issued a news release in March, calling the fungus "an urgent antimicrobial resistance (AR) threat" and noted that it "spread at an alarming rate in U.S. health-care facilities in 2020-21." 

"CDC has deemed C. auris as an urgent AR threat, because it is often resistant to multiple antifungal drugs, spreads easily in health-care facilities, and can cause severe infections with high death rates," the release says.

The article is published in Grist, an online journal of environmental news and commentary, as part of a collaboration with AP called Climate Connections, to explore how a changing climate is accelerating the spread of infectious disease around the world, and how mitigation efforts demand a collective, global response.

Ky.-based Infection-control activist calls for screening all patients, isolating infected ones, making hospital risk ratings more reliable

An infection-control activist says every hospital patient in the U.S. should be screened for a certain type of staph infection that can be deadly, citing data that shows this is the best way to decrease the spread of such infections.

Dr. Kevin Kavanagh of Somerset, chair of Health Watch USA, made several assertions and recommendations in a commentary published in the medical journal Antimicrobial Resistance & Infection Control, and also wrote an op-ed about the issue for BioMed Central. 

The commentary was prompted by new data from the federal Centers for Disease Control and Prevention showing that more than 119,000 people in America had a staph infection in 2017, and nearly 20,000 of them died from it.

These numbers reflect rates for all Staphylococcus aureus infections, including methicillin-resistant Staphylococcus aureus, or MRSA, and methicillin-susceptible Staphylococcus aureus, or MSSA.

Centers for Disease Control and Prevention chart; click on it for a larger version

After dropping by an average of 17 percent a year between 2005 and 2012, the rate of decline for hospital-onset MRSA has stalled. The report notes that the U.S. is not on track to meet its goal of 50% reduction by 2020.

Department of Veterans Affairs hospitals had a much larger decrease in MRSA infections, as opposed MSSA, since 2005: 55% and 12%, respectively.

Kavanagh says the difference is that the VA has universal MRSA surveillance and isolates all MRSA carriers, and those results mirror the results in the United Kingdom's National Health Service, which has similar infection-control practices.

"These findings support the contention that the marked decline in hospital-onset MRSA infections observed in these studies is due to interventions which are specifically targeted towards MRSA," he writes.

Kavanagh argues that because MRSA is regularly found in 2% of hospital patients, all U.S. hospitals should screen all patients for MRSA when admitted.

He says hospitals have moved away from early identification and isolation of MRSA carriers as a first line of intervention, to strategies that are based on poorly designed studies — perhaps as a reaction to patient-advocacy groups' push to mandate MRSA testing and isolation, which is costly.

Kavanagh further argues that daily bathing with the antiseptic chlorhexidine, a common practice in U.S. hospitals, is not supported by solid research. He says one study supporting it has data interpretations that have been questioned, and has "apparent conflicts of interest." He also argues that random, controlled trials haven't demonstrated uniform effectiveness of chlorhexidine bathing.

Kavanagh also points out instances where facilities have asked for "risk adjustments" to be made for their rates of hospital-acquired infections, such as adjusting the numbers to allow for high rates of infection among opioid users. He holds firm that this should not be allowed.

He argues that instead of adjusting numbers to make the problem seem less than it really is, hospitals should follow a standard of care that includes not only screening and isolation, but decolonization, which means getting rid of the MRSA virus in people who carry it in their nose or on their skin even though they are not sick with a MRSA infection.

Kavanagh says some of Kentucky's major hospitals have the highest numbers of MRSA infections in the U.S., but after manipulating the data for "risk adjustment" they are designated "no different from national benchmark."

He calls for a different way of thinking about MRSA in the U.S. that includes increased transparency; making surveillance, isolation and decolonization a standard of care that is fully funded; and a more comprehensive tracking system.

He concludes, "Until these reforms are universally enacted in the United States health-care facilities, I have grave reservations that the epidemic of drug-resistant bacteria will be brought under control."

Kentuckians use too many antibiotics; we're No. 1 in the nation, and a campaign has started to reduce inappropriate use

Kentucky has the highest rate of antibiotic use in the United States, and the University of Louisville School of Medicine is trying to do something about it.

The school's Department of Pediatrics has mounted a campaign to highlight the need for education and awareness on antibiotic overuse in Kentucky, and to reduce inappropriate use of antibiotics in the state.

“Although antibiotics are important life-saving drugs that treat bacterial infections – including strep throat and urinary tract infections – their overuse can lead to drug resistance, which occurs when antibiotics no longer cure infections that they should treat,” Bethany Wattles, a clinical pharmacist in the pediatrics department, said in a U of L news release.

“If we continue to overuse antibiotics, even minor infections will become untreatable. This is a serious public health threat,” Wattles said. “To combat the spread of antibiotic resistance, we must use antibiotics only when necessary.” 

The Kentucky Antibiotic Awareness campaign to health-care providers and the public is led by the department's Antimicrobial Stewardship Program, with support from the state Department of Medicaid Services, which finances health care for almost one-third of Kentuckians.

U of L researchers examined antibiotic prescriptions for Kentucky children on Medicaid and found that the rate of antibiotic use has been especially high in Eastern Kentucky. In some areas, children are receiving three times more antibiotic prescriptions than the national average.

"Antibiotics are most frequently used for upper respiratory infections, many of which are caused by viruses that antibiotics do not kill," the U of L release said. "The majority of antibiotic prescribing is done in outpatient settings, which include medical offices, urgent care facilities, retail clinics and emergency departments. Wattles said 30 to 50 percent of this antibiotic use is estimated to be inappropriate.

"When antibiotics are prescribed, it is important to take them as instructed; do not share the medicine with others or save for later use," the release says.

The campaign is on Facebook and Twitter. Health-care providers are encouraged to join the KAA Listserv for newsletter updates, or email KYAntibx@louisville.edu with questions and suggestions.