Candida auris: US Case Count Rising Rapidly

Candida auris is spreading rapidly throughout the United States, according to the Centers for Disease Control and Prevention (CDC).

C auris is an emerging fungus that, troublingly, is displaying antimicrobial resistance. The superbug is spreading in health care facilities across the country, with high fever and chills as the most common initial symptoms.

Since it was first reported in 2016, C auris has been steadily spreading in the US. However, a new study in Annals of Internal Medicine documented a concerning rise in C auris incidence, with cases doubling from 2019 to 2021.

The study utilized CDC national surveillance data from individuals with any specimen that tested positive for C auris. A total of 3270 clinical cases and 7413 screening cases of C auris were reported in the US through December 31, 2021. Each year, the percentage of clinical cases increased, with a 44% increase in 2019 and a 95% increase in 2021.

Additionally, 2021 saw an 80% increase in colonization screening volume and a >200% increase in screening cases. From 2019-2021, 17 states all identified their first-ever C auris case.

Echinocandins are a class of antifungals widely used to treat invasive candidiasis, primarily indicated for critically ill and neutropenic patients. Concerningly, this report found that the number of C auris cases with echinocandins resistance in 2021 had tripled in each of the preceding 2 years.

One limitation of these findings is that the identification of screening cases directly relies on the basis of need and available resources, which determine when screening is conducted. Because screening is not conducted uniformly across the country, the true burden of C auris cases is likely underestimated.

The investigators note that the rise in echinocandin-resistant cases and evidence of transmission are particularly alarming. “These findings highlight the need for improved detection and infection control practices to prevent spread of C auris,” they concluded.

Reference: Lyman M, Forsberg K, Sexton DJ, et al. Worsening Spread of Candida auris in the United States, 2019 to 2021. Ann Intern Med. Published online March 21, 2023. doi:10.7326/M22-3469