Three patients in New York had “pan-resistant” Candida auris unresponsive to three or more classes of antifungal drugs, researchers found.
These individuals had no history of recent travel. Resistance apparently developed after exposure to antifungal medications, including echinocandins, during prolonged healthcare facility stays, reported Belinda Ostrowsky, MD, of the CDC, and colleagues, writing in the
Morbidity and Mortality Weekly Report.
While the authors noted that there was no transmission of any pan-resistant isolates to other patients or the healthcare environment, they characterized this emerging pan-resistance as “concerning.”
“The occurrence of these cases underscores the public health importance of surveillance for C. auris, the need for prudent antifungal prescribing, and the importance of conducting susceptibility testing on all clinical isolates, including serial isolates from individual patients, especially those treated with echinocandin medications,” they wrote.
C. auris had been diagnosed in 801 patients in New York as of June 28, 2019, either through clinical culture or from skin and nostril swabs only. All three patients with pan-resistant C. auris were older than age 50 and had multiple comorbidities, though the first two lived in long-term care facilities, and the third had a prolonged hospital stay and long-term care admission. Ostrowsky and colleagues noted that the third patient was in different facilities in a different borough than the first two patients.
Isolates from all three patients were initially susceptible to echinocandins, but resistance emerged during treatment with these drugs, they wrote. They added that most C. auris strains are resistant to fluconazole and susceptible to echinocandins, which target the cell wall.
There was no known contact between any of the patients. While the first two patients were from the same borough in New York City, they were treated in different healthcare facilities, and the authors could find no epidemiologic link between them. All three patients died — one from underlying medical conditions, whereas C. auris could have contributed to the others’ deaths, although this was unclear.
Ostrowsky and colleagues added that while these emerging pan-resistant isolates appear to be rare, the South Asia clade of C. auris dominated in New York City, and that clade is known for increased antifungal resistance compared to other clades.
Patients on antifungal treatment for C. auris should be monitored for resistance, follow-up cultures should be obtained and an infectious disease specialist should be consulted, the authors said.
The authors disclosed no conflicts of interest.
Primary Source
Morbidity and Mortality Weekly Report
