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Drug-resistant Candida auris - Expert Reaction


There were alarming headlines from the US over the weekend about a type of yeast that has been causing serious illness in hospital patients.


Candida auris can cause invasive infections and often does not respond to commonly-used antifungal drugs, according to the Centers for Disease Control and Prevention.

The SMC asked experts about the fungi and New Zealand's preparedness.

Professor Michael Baker, Professor of Public Health, University of Otago, Wellington, comments:

"Reports about the rise of Candida auris are worrying as this organism is frequently resistant to multiple antifungal drugs. One unusual aspect of this pathogen is that it is a fungus, whereas most of the concerns about growing antimicrobial resistance (AMR) have been about bacteria. Since it was first detected and named in 2009 this organism has spread globally. A small number of cases have been detected in Australia, largely in people who have arrived from overseas. There do not appear to have been any reported cases in New Zealand to date, but it is almost inevitable that it will be seen here.

"Candida auris infections mainly occur in health care facilities (nosocomial infections) where they may cause prolonged outbreaks. It adds to the growing number of nosocomial infections that worsen outcomes for seriously ill patients, increasing mortality and the length of hospital stays. Control measures are broadly similar to those used for other resistant organisms in such settings, such as methicillin-resistant Staphylococcus aureus (MRSA).

"New Zealand microbiologists and infectious disease specialists are aware of this organism and how to diagnose, treat and control it. However, it will inevitably add to the complexity and costs of managing nosocomial infections. New Zealand is very unlikely to experience the kind of secrecy described in the New York Times articlewhere there were apparently delays in reporting such infections to protect the commercial interests of some hospitals.

"The rise of Candida auris illustrates what AMR looks like. It will probably not be a single catastrophic event like a pandemic, but more a series of reminders that we cannot rely on antimicrobial drugs to work in the same way as they have in the past. In most cases, these infections will be a particular threat to the most vulnerable, such as those will underlying illness, immune-suppressive treatment, and the very young and elderly.

"Given the inevitability of increasing AMR threats, it is important to keep asking whether New Zealand is well prepared. Are our diagnostic and surveillance capabilities and response systems sufficiently developed and organised to respond in a highly coordinated way? Hopefully, this is one of the issues that the current Health and Disability System Review can consider."

No conflict of interest.

Dr Heather Hendrickson, senior lecturer in molecular biosciences, Massey University, comments:

"Essentially, Candida auris is a yeast, not a bacterium. It has cells that are structurally more like ours (have a nucleus and mitochondria).

"It is frightening to read about because, like other superbugs, it is becoming increasingly resistant to the antimicrobials that doctors use to treat it and it is easily spread. This is also an emerging infectious organism that was first recognised in Japan in 2009 and appears to be springing up in many places around the globe simultaneously, but the isolates found in different locations are generally closely related to one another. This suggests that something environmental may be stimulating the transition of these to become serious threats in hospitals and in human patients, where they were not found previous to 2009.

"Importantly for the public in New Zealand, this is not on the list of notifiable infectious diseases here. This means that it is not publicly reported to the Medical Officer of Health if it is recognised in a hospital or lab.

"I am not aware of any reason that people in New Zealand should be overly concerned at this time. However, this is a good time to take a look at our monitoring practices and ensure that we are using the molecular tests that would allow us to identify this organism if it appeared clinically in our hospitals. Rapidly and accurately distinguishing C. auris from other infectious fungal pathogens is an important part of handling an infectious microorganism like this one."

No conflict of interest.

ends

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