New guidance from Public Health England (PHE) warns that as of last month, 20 separate NHS trusts and independent hospitals have detected more than 200 cases of patients colonised or infected with the difficult to treat fungus Candida auris. In addition, more than 35 hospitals have identified patients found to be carrying the fungus following transfer from elsewhere, officials state.
First discovered in Japan in 2009, in the ear canal of a 70-year-old woman, the family of yeasts can live on the skin and inside the body, causing complications in people with weakened immune systems. The fungus is proving difficult to control and has spread rapidly around the globe, emerging in at least five continents, with the first UK case detected in 2013.
“Three hospitals have seen large nosocomial [within hospital] outbreaks that have proved difficult to control, despite intensive infection prevention and control measures, though two of these outbreaks have been declared over and one is seeing significantly fewer numbers of new acquisitions.
“Over 35 other hospitals have had patients known to be colonised with Candida auris transferred to them.”
The PHE guidance says the hospitals with significant outbreaks have not shown an attributable rise in death rates. But the guidance also says it is important to note that these exercises did not provide comparable data on their normal mortality rates.
Commonly C. auris is resistant to the first-line antifungal drug fluconazole and this species can rapidly evolve to develop resistance, so specific antifungal susceptibility testing is indicated.
In UK laboratories, Candida species isolated from superficial sites are not routinely identified to species level or tested for antifungal susceptibility. Even if species identification is undertaken, isolates can be misidentified by some commercial kits.
Therefore any presumptive isolates of C. auris should be subjected to further testing at Public Health England’s network of public health laboratories or the national PHE Mycology Reference Laboratory.
NHS trusts have been ordered to carry out deep cleans of all affected areas.
Dr Colin Brown, PHE consultant medical microbiologist said: “PHE continues to provide ongoing expert support and advice on infection control measures to limit the spread of Candida auris in healthcare settings.
“Our enhanced surveillance of this uncommon fungus shows that in the UK it has mostly been detected in colonised patients, with a quarter being clinical infections.”