For the first time, the C.D.C. identified several cases of Candida auris that were resistant to all drugs, in two health facilities in Texas and a long-term care center in Washington, D.C.
A deadly, hard-to-treat fungal infection that has been spreading through nursing homes and hospitals across the United States is becoming even more dangerous, according to researchers, who for the first time have identified several cases in which the fungus, Candida auris, was completely impervious to all existing medication.
The finding, released Thursday by the Centers for Disease Control and Prevention, is an alarming development in the evolution of C. auris, a tenacious yeast infection discovered in Japan in 2009 that has since spread across much of the world.
Federal health officials say the bug has spread even more widely during the coronavirus pandemic, with overwhelmed hospitals and nursing homes struggling to keep up with the surveillance and control measures needed to contain local outbreaks.
In the new report, the C.D.C. said, five of more than 120 cases of C. auris were resistant to treatment.
The C.D.C. did not identify the facilities where the novel infections took place, but health officials said there was no evident link between the outbreaks, which occurred in Texas at a hospital and a long-term care facility that share patients, and at a single long-term care center in Washington, D.C. The outbreaks took place between January and April.
Nearly a third of the infected patients died within 30 days, according to the C.D.C., but because they were already gravely ill, officials said it was unclear whether their deaths were caused by the fungus.
Over the past eight years, the C.D.C. has identified more than 2,000 Americans colonized with C. auris — meaning the fungus was detected on their skin — with most cases concentrated in New York, New Jersey, Illinois and California. Between 5 and 10 percent of those colonized with the pathogen go on to develop more serious bloodstream infections.
Once it gains a foothold, the fungus is difficult to eliminate from health care facilities, clinging to cleaning carts, intravenous poles and other medical equipment. While relatively harmless to those in good health, the yeast infection can be deadly to seriously ill hospital patients, residents of long-term care facilities and others with weakened immune systems.
“If you wanted to conjure up a nightmare scenario for a drug-resistant pathogen, this would be it,” said Dr. Cornelius J. Clancy, an infectious diseases doctor at the VA Pittsburgh Health Care System. “An untreatable fungus infection would pose a grave threat to the immunocompromised, transplant recipients and critically ill patients in the I.C.U.”
While C. auris has long been notoriously hard to treat, researchers for the first time identified five patients in Texas and Washington, D.C., whose infections did not respond to any of the three major classes of antifungal medication. So-called panresistance had been previously reported in three patients in New York who were being treated for C. auris, but health officials said the newly reported panresistant infections occurred in patients who had never received antifungal drugs, said Dr. Meghan Lyman, a medical officer at the C.D.C. who specializes in fungal diseases.
“The concerning thing is that the patients at risk are no longer the small population of people who have infections and are already being treated with these medications,” she said.
Infectious disease specialists say the coronavirus pandemic has probably accelerated the spread of the fungus. The shortages of personal protective equipment that hobbled health care workers during the early months of the pandemic, they say, increased opportunities for the fungus’s transmission, especially among the thousands of Covid-19 patients who ended up on invasive mechanical ventilation.
The chaos of recent months also did not help. “Infection control efforts at most heath care systems are stretched thin in the best of times, but with so many Covid patients, resources that might have gone to infection control were diverted elsewhere,” Dr. Clancy said.
For many health experts, the emergence of a panresistant C. auris is a sobering reminder about the threats posed by antimicrobial resistance, from superbugs like MRSA to antibiotic-resistant salmonella. Such infections sicken 2.8 million Americans a year and kill 35,000, according to the C.D.C.
Dr. Michael S. Phillips, chief epidemiologist at NYU/Langone Health, said health systems across the country were struggling to contain the spread of such pathogens. The problem, he said, was especially acute in big cities like New York, where seriously ill patients shuttle between nursing homes with lax infection control and top-notch medical centers that often draw patients from across a wider region.
“We need to do a better job at surveillance and infection control, especially in places where we put patients in group settings,” he said. “Candida auris is something we should be concerned about, but we can’t lose sight of the bigger picture because there are a lot of other drug-resistant bugs out there we should be worried about.”