Controlling Candida auris (C auris) can be achieved through the use of antibiotics, antifungals, and onsite diagnostics. During outbreaks, the CDC works closely with local and state health departments to offer expert guidance and support.
In this final installment of their interview with Infection Control Today® (ICT®), Megan Lyman, MD, medical officer, Mycotic Diseases Branch, CDC, and Danielle A. Rankin, PhD, MPH, health scientist, Division of Healthcare Quality and Promotion, Prevention and Response Branch, Antimicrobial-Resistance Team, CDC, discuss what can help with controlling and preventing the spread of) C auris. This initial interview was conducted in collaboration with our colleague Chris Spivey, editorial director for Pharmaceutical Technology, Pharmaceutical Technology Europe, and BioPharm International.
The first is here. The second installment is here. The third installment is here.
Chris Spivey: In the armamentarium, because of the economics, there haven’t been many new drugs coming online. What is it that you have lacked the most [to combat C auris]? It used to be gram-negative antibiotics, but has that changed? Or what is it if it’s not a drug? It seems to me that the C auris’s threat is its colonization and ability to slowly transmit through plasmids over time. If you were to argue that you wanted to cut down on that [threat], what would be better–cleaning disinfectants? Would it be a drug?
Megan Lyman, MD: C auris does not have plasmids. But there are several things that would help with control. Obviously, antifungals are of interest because there are so few, and some in the pipeline are very promising for C auris and getting close [to being approved]. So that’s reassuring. The other thing is diagnostics. Something that would make such an impact is a point-of-care diagnostic that could be done even in settings like long-term care settings, where they don’t have a clinical lab. Those results would be available almost immediately, so you could act on them and implement precautions, making admission screening much easier. You wouldn’t have days of waiting on those results before you can act on them. Then the final thing that would be impactful that we don’t know much about is treatments for colonization. We do not recommend treating for colonization without signs and symptoms of infection. But there is interest to learn if there are products that can be used to decrease skin burden to prevent infection in that patient and mitigate transmission to other patients.
CS: I’m surprised I thought in that era of the microbiome, there’d be more of that going on. But I do take your point about the diagnostic, and it wouldn’t be a multi-analyte you’re talking about a swab, something specific to C auris. I want to help lobby at some point for that. Because even though I don’t take care of diagnostics, I can see the wisdom in that.
How do you get your messenger in an increasingly busy world? And then, how do you pick that message? What do you how do you triage what’s the most important?
ML: C auris has gotten a lot of attention, which can be very helpful in getting that message out. But there’s sometimes some misinformation or misunderstanding, which can cause fear that’s not always appropriate. So one of the important messages is mostly at public health and health care facilities because that’s where a lot of prevention happens. And the public and community need to be aware to advocate. But there isn’t as much frontline prevention that they need to do. So it’s being aware, but most of the general public is not at risk. Ultimately, they or their family members could be affected if they have the risk factors or are in health care settings where transmission can occur.
Most of what we do is work very closely with health departments. And they have a lot on their plate because they were often once the ones trying to help with COVID-19. But some areas have a very high burden of C auris. They have been working very hard, even throughout COVID-19, to try and give C auris and other resistant organisms the appropriate attention.
Where we struggle is with areas and facilities where it’s not a high burden, and they haven’t had cases. Usually, people start to pay attention once they have cases, and sometimes that’s too late, [and] there’s already been transmission. So we recommend being proactive, instead of reactive, and starting these efforts to identify cases and improve infection control, even before they have their first case and spread. That’s a hard message that doesn’t hit home for many people until they have their first case.
Danielle A. Rankin, PhD, MPH: As Megan had indicated, when we’re trying to be more proactive, we’ve rolled out a couple of different prevention strategies and plans. And Meghan and I worked very closely with the health departments. We’re on calls all the time with them. And so the Health Department receive funding from CDC to do these prevention efforts and help pay for the resources needed to do colonization screening. So that’s free of charge for health care facilities. It goes through public health. We help strategize. Not every situation is one size fits all approach. Many times, Meghan and I will get on a phone call with the health care jurisdiction and try to strategize what are the best measures going forward, based on any barriers they’re hitting, to be able to help with either that prevention or the containment efforts depending on the situation for the health departments to get that messaging across to the health care facilities that they are dealing with.
For our messaging, as Megan had indicated, it’s with the health departments that help get that messaging across to the health care facilities as well. And we help train them and provide that guidance and strategies as needed.
ICT: Do you have anything else you would like to add, to emphasize, or point to before we finish?
DS: I had an additional infection prevention measure that goes beyond the basics that I wanted to mention: for health care facilities to ensure that they’re conducting surveillance within their facility, where they’re able to track and flag their patients and residents’ charts. If, for instance, a patient or their resident becomes positive for C auris and is readmitted back into their facility. Their medical record would be able to alert the facility to place them on the appropriate transmission-based precautions. The patient or resident would not get rescreened, but it helps establish that the transmission-based precautions layer to help prevent transmission and spread within that facility.
ML: We often hear about these bad outbreaks and many transmissions, but it’s important for people to realize that spreads are not inevitable, and we don’t want them to lose hope or think that all these efforts will not be effective. Some areas and health care facilities have not experienced spread after admitting a case, or they’ve had a large outbreak and have been able to contain it, obviously with much work. It’s just like a cautionary tale. I hope that what we’ve learned about C auris and the improvements we’ve made, especially in infection control, will help prevent the spread of the next emerging threat.