Candida auris: When hospitals become a source of infection

In a study of 27 intensive care units in hospitals across the country, 19 were seen having Candida auris, says Dr Arunaloke Chakrabarti. Candida auris is the multi-drug resistant fungus that has public-health authorities across the world very worried.

“It is a fungus that behaves like a bacteria, developing resistance to medicine with greater speed than a fungus normally would,” says Chakrabarti, Head (Department of Medical Microbiology) at Chandigarh’s Postgraduate Institute of Medical Education and Research, coordinator of the 2011 study.

World-wide scare

The recent concern over C. auris comes even as Governments across the world tackle antimicrobial resistance (AMR), a scenario where an antibiotic is unable to treat or control the simplest of bacterial infections due to resistance developed against the drug by the bacteria.

Read More:‘Multi-drug-resistant yeast present in India since 2011’

“In the fungal world, C.auris is a bad bug,” says Dr Abdul Ghafur, Coordinator with the Chennai Declaration on AMR. However, he adds, “While I see C.auris about once a month, I have seen people dying of multi-drug resistant bacteria daily.” Be it a bacterial or fungal infection, the need is for better infection control in hospitals and to take measures outside the hospitals as well, he says. For instance, just as antibiotic resistance was being tackled by addressing antibiotic use in poultry, he said, the use of fungicide in agriculture could be one of the reasons for an emergence of C. auris.

Explaining why C.auris is a concern, the United States Centres for Disease Control and Prevention says, it can cause “bloodstream infections and even death, particularly in hospital and nursing home patients with serious medical problems. More than 1 in 3 patients with invasive C. auris infection (for example, an infection that affects the blood, heart, or brain) die.”

Disinfecting colonies

Chakrabarti adds that C.auris was increasingly catching the attention of healthcare providers because it resides largely in hospital ICUs and spreads fast.

A local study in 2013 found that all patients in an ICU were “colonised” within four days of finding a patient with C.auris. The fungus spreads through moist surfaces, hospital linen, blankets, temperature probes etc, he says, recalling an instance when a ventilator had to be destroyed because it could not be properly disinfected.

In 2017, the Indian Council of Medical Research (ICMR) had issued an advisory for hospitals to tackle C.auris.

Disinfection procedures ranged from simple handwashing to isolating “colonised” patients and subjecting them to body-washing with chlorhexindine, says Chakrabarti, who is also in-charge at the Center of Advanced Research in Medical Mycology at the WHO (World Health Organsiation) Collaborating Center for Reference & Research on Fungi of Medical Importance. Infection control protocols at hospitals should involve strong disinfectants and exposure to them for about 15 minutes. But this is sacrificed often due to the large number of patients at hospitals, he observed.

Pro-active approach

Dr Prakash Peralam Yegneswaran , Associate Professor in Microbiology & Incharge Mycology Laboratory at the Manipal Academy of Higher Education, adds that C.auris had been notified by the ICMR, so hospitals will have to report its occurance to higher authorities.

Calling for a more pro-active approach, he says, patients who have a long stay in hospitals of over 10 days and with underlying risk factors including fever etc should be screened for C.auris. “Since it is an environmental contaminant, the hospital could become a potential source of infection,” he says, stressing the need for upgraded hospital labs to identify the strain, trained and alert staff and access to new generation drugs.

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