Pan-resistant Candida auris healthcare clusters

New MMWR Notes from the Field publication

Transmission of pan-resistant and echinocandin-resistant Candida auris in United States

CDC’s Morbidity and Mortality Weekly Report recently released Notes from the Field noting independent clusters of Candida auris (C. auris) with concerning levels of resistance in healthcare facilities in Texas and Washington, D.C.  From January – April 2021, state health departments detected two independent clusters of pan-resistant and echinocandin-resistant cases of C. auris, an urgent threat in the United States. In two Texas facilities in the same city, there were 22 cases identified—two pan-resistant cases and five resistant to echinocandins and fluconazole. In Washington, D.C., there were 101 cases, including three that were pan-resistant. Cases for both clusters were identified through skin colonization screening and/or clinical isolate testing, which were confirmed through CDC's AR Lab Network.

Why is this important?  These patients were not known to have been treated with antifungal medication previously, suggesting transmission of pan- and echinocandin-resistance for the first time in the United States. There have not been any known epidemiological links between the two clusters.  With only three classes of antifungals available, treatment options for C. auris infections are limited and very few options exist for treatment of cases that are pan-resistant or echinocandin-resistant. Prior to 2020, reports of pan-resistant C. auris in the United States and abroad were extremely rare.  What can clinicians and healthcare facilities do?  Resistance to echinocandins is a concerning public health threat of which healthcare professionals should be aware.  Early identification, rigorous infection control, and coordinated communication between laboratory staff, clinical staff, and among facilities about C. auris cases are essential to prevent its spread, particularly echinocandin-resistant and pan-resistant strains.  Antifungal susceptibility testing is critical for early identification of antifungal resistance and guiding treatment decisions. Healthcare clinicians should conduct antifungal susceptibility testing in patients with C. auris infection, especially in those with treatment failure, and consider screening healthcare contacts of newly identified C. auris cases.  Through the AR Lab Network, CDC provides colonization screening for C. auris and other resistant pathogens free of charge to healthcare facilities. Clinicians should alert their state or local health department about new cases of C. auris as well as the identification of C. auris echinocandin resistance.  Data about outcomes and treatment of patients with pan-resistant and echinocandin-resistant infections are limited. More research is needed to identify the appropriate treatment for pan-resistant infections.

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