Seventeen health care facilities on Long Island have treated people with Candida auris, a deadly, drug-resistant fungus, according to state health officials.
Candida auris, also known as C. auris, is primarily found in hospitals and long-term health care sites, where it targets the most vulnerable patients with severe medical problems and compromised immune systems.
The pathogen has triggered health alarms around the globe because even the most reliable antifungal medications have had trouble stopping it from causing infections.
Through Oct. 23, the New York State Health Department has tracked 415 cases in which individuals were ill and had C. auris detected, and another 594 cases in which people were not ill but C. auris was detected through a public health investigation.
The Centers for Disease Control and Prevention lists 836 confirmed clinic cases of C. auris across the United States, along with another 1,600-plus cases that were carriers who were not sick from infection.
C. auris was one of the major issues highlighted by experts from the CDC when it released a report on “Antibiotic Resistance Threats in the United States” this week. Each year, more than 2.8 million infections and 35,000 deaths in the United States can be traced to antibiotic-resistant bacteria and fungi.
“Candida auris is a newly listed urgent threat in this report,” CDC director Dr. Robert Redfield said in a media briefing Wednesday. “This fungus has only recently emerged as a deadly germ … We must remain vigilant.”
CDC officials said based on a limited number of patients, 30% to 60% of people with C. auris infections have died, but they point out many of those patients were also seriously ill and had a higher risk of death.
New York is the only state in the nation to release the names of facilities where C. auris was treated in patients. The list, posted on the state Health Department website, includes 64 hospitals and 103 long-term care facilities, with the majority found in New York City.
Seven of the Long Island facilities that have treated patients with C. auris infections are North Shore University Hospital, Glen Cove Hospital, Huntington Hospital and Southside Hospital, all operated by Northwell Health, as well as Mount Sinai South Nassau Hospital, NYU Winthrop Hospital and Stony Brook University Hospital.
In addition, 10 privately run nursing homes and rehabilitation centers also have treated patients with C. auris.
All of the facilities that responded to interview requests from Newsday said patients with C. auris are isolated and extensive cleaning measures are used to prevent the fungus from spreading.
Dr. Mark Jarrett, chief quality control officer at Northwell Health, supported the state’s decision to post the list.
“Any transparency is good,” he said, adding the long list shows the fungus is widespread.
Larger hospitals that provide more complex care are more likely to have patients with C. auris, because patients who are very sick are more likely to carry the fungus, he said.
“As time goes on, unfortunately we probably will see cases in almost every institution,” he said. “That’s the reality of the ecology of this organism.”
State Deputy Health Commissioner Brad Hutton said the agency is developing guidelines for hospitals and nursing homes.
When a facility reports its first case of the fungus to the state, the department sends a team to take samples from patients who were in the same unit or nearby rooms as the patient with C. auris, Hutton said.
Part of the state’s educational outreach is advising facilities on the rigorous cleaning of areas that may be contaminated by the fungus, he said.
“This fungus is especially hardy, and there are certain cleaning chemicals they need to use that are different from what they normally use,” Hutton said.
Dr. Aaron E. Glatt, chief of infectious diseases and hospital epidemiologist at Mount Sinai South Nassau Hospital, said the vast majority of C. auris cases are in very sick patients.
“This is nothing that is going to spread like wildfire in the healthy community; flu can do much more devastation,” he said. “But we are very aware of this, and the major thing is to identify it as early as possible.”
It’s still unclear how widespread the fungus is, Jarrett said.
“It is out in the community, and we postulate that eventually this organism may start to get more out in the community …,” he said. “People spread things. You go shake someone’s hand. In New York City, you go ride the subways and you’re holding on the strap. You don’t know who was on the strap before and then you rub your eye or you touch your mouth and now you’re colonized.”
Jarrett said people with the fungus generally have been very sick patients, perhaps because they’re more likely to be exposed to it in skilled nursing facilities or hospitals, and because they’re often on multiple antibiotics. Overuse of antibiotics can make someone more susceptible to the fungus, and one way to help stem the spread of C. auris is to be judicious in administering antibiotics, he said.
Glatt said patients who are even suspected of having C. auris are put in isolation where staff use strict sanitary protocols that include the use of protective gear for everyone who enters the room, as well as equipment that stays in the room. An intensive steam cleaning process is used once rooms become vacant.
NYU Winthrop spokeswoman Anne Kazel-Wilcox said the hospital's single case in 2017 involved a patient who tested positive for C. auris while in another facility. They placed the patient in isolation and employed a cleaning regimen that included using a robot to sterilize surfaces with a UV light after disinfecting the linens, mattress, bedframe, tables and other objects.
In a statement, Stony Brook University Hospital said it treated one patient earlier this year with C. auris and used "key infection prevention measures" and followed CDC guidelines to stave off a spread of the fungus.
Maryellen Towey, director of nursing at Meadowbrook Care Center, said the facility had only one case after a patient transferred from a hospital in the city more than a year ago. That patient was put in isolation, and there was no spread of C. auris.
“The state Health Department and the CDC were both here to observe and do tests," she said. “We have very good infection control measures.”
Staff at the Medford Multicare Center had a similar situation, when a patient transferred from a Queens hospital in early 2018, said Elizabeth Murray, assistant director of nursing and the center’s infection preventionist.
The center put the man — who had tested positive for the fungus in Queens — in an isolated room, in which staff wore special clothing and medical equipment always stayed in the room and was never used on other patients, to prevent contamination, she said. No other residents have tested positive for the fungus.
ABOUT CANDIDA AURIS
Candida auris, also known as C. auris, is a drug-resistant fungus that can cause serious infections and is considered a global health threat by the Centers for Disease Control and Prevention. It has caused outbreaks in hospitals and health care facilities around the country. The CDC has reported 836 confirmed cases. The New York State Health Department has tracked 415 cases in which individuals were ill and had C. auris detected.
- C. auris was first identified in Japan in 2009, but researchers now believe the earliest known strain was found in South Korea in 1996.
- The CDC said C. auris spreads mostly in hospitals and other long-term health care facilities among patients with severe medical problems and compromised immune systems, including organ transplant recipients, people with cancer, HIV/AIDS or other forms of immune suppression. Patients with a central venous catheter and other lines and tubes in their body or who previously have received antibiotics or antifungal medications appear to be most at risk.
- C. auris can spark infections in the bloodstream, wounds and ears of patients. Many antifungal drugs that are usually able to treat infections have proved unsuccessful in battling some strains of C. auris.
- C. auris, which is odorless and invisible, can spread through contact with contaminated environmental surfaces and equipment (such as floors, food trays, phones) as well as from person to person.
SOURCE: Centers for Disease Control and Prevention/Newsday research
CANDIDA AURIS ON LONG ISLAND
These health care facilities on Long Island have cared for persons with Candida auris infection or colonization as of June 28.
North Shore University Hospital
Glen Cove Hospital
Mount Sinai South Nassau
NYU Winthrop Hospital
Stony Brook University Hospital
LONG-TERM CARE CENTERS
Excel at Woodbury for Rehabilitation & Nursing
Fulton Commons Care Center
Meadowbrook Care Center
Nassau Rehabilitation & Nursing Center
South Shore Rehabilitation and Nursing Center
The Five Towns Premier Rehabilitation and Nursing Center
The Grand Rehabilitation & Nursing at South Point
Townhouse Center for Rehabilitation and Nursing
Medford Multicare Center
SOURCE: New York State Department of Health