PEORIA — Illinois currently has the second highest number of confirmed cases of a new superbug spreading across the United States.
Candida auris, a new strain of yeast, can cause serious infections and is resistant to antifungal medications and many disinfection methods. According to the Centers for Disease Control and Prevention, patients most at risk are those who have been hospitalized for a long time, have a central venous catheter or other lines or tubes entering their body, or have previously received antibiotics or antifungal medications.
Between May 24, 2016 and April 4, 2019, 154 confirmed and four probable clinical cases were identified in Illinois, according to the state's Department of Public Health. Most were reported in the Chicago area. There have been no cases reported in either Peoria or Tazewell Counties, according to representatives from the Peoria City/County Health Department and the Tazewell County Health Department.
A total of 587 cases and 30 probable cases were reported in the U.S as of Feb. 28, according to the CDC. New York reported 309, and New Jersey reported 104 cases.
Though healthcare providers have been keeping an eye on C. auris since the CDC issued the first clinical warning in 2016, most people in the general public didn’t hear about it until a recent spate of publicity. A New York Times article on the proliferation of superbugs highlighted the difficulty some hospitals were having getting rid of C. auris after their facilities were infected. In 2015 a hospital in London was forced to shut down it’s intensive care unit for 11 days while trying to eradicate C. auris, and a year ago a hospital in Brooklyn had to tear out ceilings and floors to eliminate the fungus from the room of a patient who had died.
One of the issues hospitals are facing is that C. auris isn’t easy to identify with standard laboratory methods, says the CDC. It can be misidentified in labs without specific technology, and misidentification can lead to inappropriate management.
“We have been monitoring very closely for C. auris,” said Lori Grooms, director of infection prevention and control with OSF HealthCare. The lab at OSF HealthCare St. Francis Medical Center can screen for the fungus and hospitals from all over the OSF HealthCare system use the lab to screen for C. auris.
UnityPoint Health is also equipped with the technology needed to detect C. auris, said Jennifer Liberty, UnityPoint’s Infection Prevention Coordinator.
“We have a real-time clinical surveillance system to help identify infections early so we can initiate appropriate infection control measures to reduce the risk of transmission,” she said. “In addition, we use a sporicidal disinfectant for daily and terminal cleaning that is effective against C. auris.”
The names of patients in Illinois who test positive for C. auris must be placed on a special, state-wide registry called XDRO, short for ‘extensively drug-resistant organisms drug registry,’ said Grooms. Patients admitted to the hospital are cross-checked on the registry. If an infected individual shows up in a healthcare facility, the staff knows to isolate him or her to keep the organism from spreading around the facility.
C. auris is actually the second organism to be placed on the XDRO registry, which was created in 2013 for another frightening superbug, a bacteria called CRE, carbapenem-resistant Enterobacteriaceae.
“C. auris is going to follow the same trajectory of CRE,” said Dr. John Farrell, an infectious disease specialist who heads the microbiology lab at the University of Illinois College of Medicine Peoria. “There is nothing new under the sun, and this is another example of another organism that is going to be a hospital-based pathogen. It’s going to move coast to coast just like CRE did a decade ago, and we are gonna see patients with it, and some of them are gonna die. When CRE first hit the map, the CDC was quoting a mortality rate of 70%. That’s higher than C. auris, which is about 60%.”
If there is any good news about C. auris, it’s that it is not making healthy people sick. Like all yeast infections, C. auris is an opportunistic organism that overgrows when the normal balance of organisms in the patient are killed off by antibiotics, said Farrell. Most at risk are patients who have been taking powerful antibiotics.
“Patients carrying C. auris are patients who have been exposed to lots of ‘gorillacillin,’” he said, creating a euphemism for last-ditch antibiotics like carbapenem. “The reason you develop C. auris and CRE is because they are the only thing that can survive when you are on ‘gorillicillin.’”
Careful use of antibiotics is key to managing this issue, said Farrell
“We are being proactive and trying to reduce the use of these extremely broad, extremely powerful antibiotics,” he said. “The protocols are in place and we try to adhere to them as strictly as possible, to ensure that patients aren’t on these powerful antibiotics any longer than necessary.”
Grooms said that patients with IV lines, wounds, urinary catheters, tracheostomies, or those on long-term ventilation are more at risk for contracting C. auris.
“With patients who are very ill or in long term care it’s something to make note of — this yeast is out there — and begin to ask questions,” she said. “Any time we put a line in a patient, the question should be how long does this need to be in, and do they still need it. Prompt removal of lines is very important, especially for patients in the hospital.”
Proper hygiene by both healthcare providers and visitors is extremely important for very sick patients, said Grooms.
“Hand hygiene is key any time you are working with a patient. Clean your hands when you go in and out of a room, and any time you are working with a loved one. When you are helping them eat or move around in bed, washing your hands before and after is key.”
Some of the precautions now in place for dealing with the inevitable appearance of C. auris were already in place for CRE. Superbugs are a new fact of life for hospitals.
“Inevitably, in the arms race between the doctors and the resistant organisms, the organisms are always one step ahead,” said Farrell.
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