Candida auris is an emerging fungus that presents a serious global health threat. CDC is concerned about C. auris for three main reasons:
- It is often multidrug-resistant, meaning that it is resistant to multiple antifungal drugs commonly used to treat Candida infections.
- It is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology. Misidentification may lead to inappropriate management.
- It has caused outbreaks in healthcare settings. For this reason, it is important to quickly identify C. auris in a hospitalized patient so that healthcare facilities can take special precautions to stop its spread.
Most C. auris cases in the United States have been detected in the New York City area, New Jersey, and the Chicago area. Strains of C. auris in the United States have been linked to other parts of the world. U.S. C. auris cases are a result of inadvertent introduction into the United States from a patient who recently received healthcare in a country where C. auris has been reported or a result of local spread after such an introduction. Chicago has been proactive in identifying patients with infections and patients who are carriers. Chicago has seen a larger number of cases due in part to our investigative work, but also due to the number of healthcare facilities in the city. Chicago C. auris death-related cases are on trend with those reported by the CDC nationwide.
Cases identified in the Chicago area and Illinois are considered part of one large, multijurisdictional outbreak involving multiple facilities across the spectrum of care. C. auris is just one of several superbugs public health has been responding to in Illinois. The Illinois and Chicago Departments of Public Health are working with health care facilities to implement infection control practices to reduce transmission (cleaning and disinfection of environmental surfaces and shared equipment, hand hygiene, gloves, gowns, etc.). Public health officials are conducting surveillance for clinical cases and also conducting surveys to identify patients who may carry C. auris on their skin. Public health investigates every clinical case to identify any common exposures in an effort to reduce further spread.
Some level of antimicrobial-resistant bacteria and fungi may be found in all hospitals. Resistant organisms identified at one facility may have been acquired in other healthcare settings as patients move between facilities while receiving care. CDPH encourages all facilities to test patients to detect drug-resistant organisms; when a facility detects a drug-resistant organism in a patient, it does not mean that the organism was acquired at the testing facility. Facility burden of drug-resistant organisms is highly related to the types of care provided and the number of facilities from which a hospital accepts patients.
In Illinois as of April 4, 2019, C. auris has primarily been identified among individuals with serious underlying medical conditions, and those who had prolonged admissions to high acuity long-term care facilities within 3 months of identification. Long-term acute care hospitals and skilled nursing facilities that care for patients requiring mechanical ventilation are more likely to house patients who may carry C. auris and other multi-drug-resistant organisms, because of the patient population and extended length of stay at these facilities. A list of Chicago facilities able to provide this level of care may be found here. CDPH provides sustained technical assistance and support to these high-acuity long-term care facilities for improved infection control capacity and increased patient safety.
Public health has provided clinical alerts to hospitals, providers, and laboratories – providing guidance on testing, patient management, and appropriate infection control recommendations.
CDPH and IDPH continue to work diligently to educate health care facilities, physicians, and individuals about the judicious use of antimicrobials and actions that can help prevent antimicrobial resistance spread.
Key Information and Action Steps
All Candida isolates from sterile sites should be identified to the species level. C. auris is most commonly misidentified as Candida haemulonii. Testing Candida isolates from non-sterile sites to determine species should be considered if:
- - clinically indicated (e.g. suspected treatment failure)
- - there is an epidemiological link to a known C. auris patient, or
- - patient has recent hospitalization in a country with known C. auris transmission
Report to public health any of the following:
- - C. auris
- - C. haemulonii
- - Any Candida isolate for which species identification was attempted, but could not be determined
- - Other organisms for which C. auris can be misidentified
Recent CDPH Health Alerts concerning C. auris
Candida auris public health reporting in Illinois - 10/29/2018
During normal business hours, Monday through Friday (excluding holidays)*:
- If a patient with C. auris is detected or suspected, please report to the Communicable Disease Program at the Chicago Department of Public Health for further recommendations by contacting Kelly Walblay (312-746-8223, Kelly.Walblay@cityofchicago.org).
*After hours, weekends, and holidays, call 311 and ask for the communicable disease physician on-call (or 312-744-5000 if outside the City of Chicago).
For questions related to Healthcare Associated Infection/Antibiotic Resistance, please contact the Chicago Department of Public Health at: CDPHHAIAR@cityofchicago.org