'Alarming' spread of emerging fungal infection across healthcare facilities in 2020 and 2021, CDC finds

The emerging fungal infection Candida auris spread among U.S. healthcare facilities “at an alarming rate” in 2020 and 2021, the Centers for Disease Control and Prevention (CDC) warned this week alongside the release of new surveillance data.

The fungus, a type of yeast, primarily spreads among hospital patients with compromised immune systems and does not respond to common antifungal drugs, according to the agency. It was first reported in the U.S. in 2016.

The new data, published by CDC researchers in Annals of Internal Medicine, outlined its progressive increase to 3,270 clinical cases and 7,413 screening cases (in which C. auris is detected by not causing infection) through the end of 2021.

The largest jumps, however, occurred alongside the pandemic, CDC researchers said.

Clinical cases increased from 476 cases in 2019 to 1,471 cases in 2021, while screening cases tripled to a total of 4,041 just between 2020 and 2021, they wrote in the journal.

Seventeen states identified their first cases of the fungus between 2019 to 2021, the researchers wrote. Most cases occurred in post-acute care settings such as long-term acute care hospitals.

“Equally concerning” to the agency was a concurrent increase in the number of C. auris cases that were resistant to the most commonly recommended antifungal medicine, echinocandins. Such cases roughly tripled in 2021 compared to the preceding two years, researchers wrote.

“The rapid rise and geographic spread of cases is concerning and emphasizes the need for continued surveillance, expanded lab capacity, quicker diagnostic tests and adherence to proven infection prevention and control,” CDC epidemiologist Meghan Lyman, M.D., lead author of the paper, said in a release.

The CDC said in a release that it has “continued to see an increase in case counts for 2022.” Between 30% to 60% of those with C. auris infection have died, though “many of these people had other serious illnesses that also increased their risk of death,” the CDC wrote on its website, citing data from “a limited number of patients.”

The agency attributed the upward trend to, among other factors, poor infection prevention and control practices among healthcare facilities and increased detection efforts.

Additionally, “the timing of this increase and findings from public health investigations suggest C. auris spread may have worsened due to strain on healthcare and public health systems during the COVID-19 pandemic,” the agency said.

The CDC has previously pointed to hospitals’ pandemic struggles as a driver of hospital-acquired and drug-resistant infections. Numbers released last summer, for instance, suggested that “historic gains” in antibiotic stewardship during the run-up to COVID-19 largely reversed as early as 2020.