New York health officials are considering guidelines that would be the first in the nation aimed at preventing the spread of a multidrug-resistant fungus — Candida auris — that has found its way into health care institutions statewide.
Among the possibilities are tough, state-mandated guidelines that would require pre-admission laboratory tests for hospital and nursing home patients considered at high-risk of carrying the fungus. Screening results would be used for triaging patients to isolation units.
The organism is problematic because it can’t be easily treated in some patients. It is also an environmental problem that has led some hospitals to rip out portions of floors, walls and ceilings because the fungus has so tenaciously contaminated hospital rooms.
New York Health Commissioner Howard Zucker met a week ago in Manhattan with representatives from approximately 60 hospitals and nursing homes from throughout the state, including institutions from Long Island, seeking suggestions from health care representatives on possible mandatory pre-admission screenings, and other methods of control. The fungus has been known to have a staggeringly high mortality rate in patients considered to be among the sickest of the sick.
With New York recording more than 300 of the 613 cases reported nationwide, the state has been disproportionately affected by the organism first identified in Japan a decade ago. Since that time, the fungus, has spread explosively worldwide.
“The state quite appropriately approached the 60 hospitals to say let’s start a dialogue, so we can come up with a plan,” said Dr. Mark Jarrett, senior vice president and chief quality officer for Northwell Health, which has 23 hospitals in its network that spans throughout Long Island, New York City and beyond.
Candida auris — or C. auris — is considered an emerging infectious disease by the Centers for Disease Control and Prevention. Some infections have thwarted every approved antifungal drug. The organism has been found in hospitals statewide, including those in Nassau County. None have been reported to date in Suffolk.
Jarrett said the impetus behind screening, which could prove prohibitively expensive for some institutions, is to isolate patients who are carriers or who have active infections. The problem, he added, is that it is difficult to run screening tests on C. auris because results are not rapidly available. It can take anywhere from seven to 10 days to obtain a result, Jarrett said.
“We really don’t know what the prevalence of this organism is in the community,” he added, referring to the general public. MRSA, for example, was once a highly infectious drug resistant bacterium found only in hospitals. But over the course of several years, MRSA has spread into communities worldwide.
“We don’t know if it’s like MRSA where in some communities 25 to 30 percent of the population has it, and they’re walking around with no symptoms,” Jarrett said.
If C. auris turns out to be as prevalent as MRSA, legions of people could wind up in isolation. That’s why it is important to carefully craft the guidelines, Jarrett said.
He added that most of New York’s cases have occurred in patients from Brooklyn and Queens, which raises the question whether anyone from these two New York City boroughs should be automatically screened.
Zeynep Sumer King, a vice president of the Greater New York Hospital Association, said guidelines are important because multidrug-resistant organisms are a major public health concern.
“As with other drug-resistant organisms, hospitals are taking Candida auris very seriously, especially its detection and controlling its spread. Fortunately, not all patients who test positive for C. auris become sick,” King said, referring to people who are colonized — carriers of the organism, but who do not have active infection.
“It appears to impact those who are already very ill,” she added, referring to people with compromised immune systems.
Even though other infectious organisms are more pervasive than C. auris, state health officials said it’s important at this juncture to implement strong control measures before the fungus becomes even more problematic. The meeting last week involved microbiologists, hospital infection control professionals and experts in fungal diseases.
“It’s correct that bacterial multidrug-resistant organisms are currently more pervasive than C. auris,” Jonah Bruno, a spokesman for the state Health Department said in a statement. “However, C. auris is so new that we don’t know what its ultimate impact might be. It has been devastating in health care facilities in some other countries when aggressive infection control measures could not be implemented early.”
The guidelines are expected to be implemented by the end of the year.
ABOUT CANDIDA AURIS
- C. auris, as it is known, became entrenched in New York about eight years after its initial detection in Japan in 2009. Doctors there isolated the microbe from a patient who had an ear infection. However, studies in South Korea of archived biological specimens suggest C. auris may have been evident in that country as early as 1995. How it became the source of a New York outbreak is still a matter of debate.
- Some scientists posit that C. auris spread around the world after its discovery in Japan. Others suggest simultaneous infections that began globally, all around the same time.
- The microbe clings to surfaces in hospital rooms, flourishes on floors, and adheres to patients’ skin, phones and food trays. It is odorless and invisible.
- C. auris can cause lethal bloodstream infections in people with weakened immunity, which include organ transplant recipients, anyone with cancer, HIV/AIDS or other forms of immune suppression.
Sources: Centers for Disease Control and Prevention/Newsday research