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NICD study shows high levels of candida auris infections in private hospitals

A National Institute for Communicable Diseases (NICD) study shows that over two-years, there were almost seven times as many candida auris infections in private hospital patients, as among state hospital patients.

Candida auris is a type of fungus that is often resistant to a single class of medicine, but some strains are resistant to all medications. The NICD study was published in Emerging Infectious Diseases.

The NICD’s data shows that four in ten infected patients die. The fungus can cause bloodstream infections or meningitis, and only affects already-sick patients with weak immune systems.

There were 794 infections in hospitals countrywide in 2016 and 2017, of which 695 were in hospital patients in private hospitals and 99 in state hospitals. The study, note the authors, might have underestimated the incidence risk in the public sector.

“Scientists and public health officials do not understand where candida auris came from, though some have speculated that the global climate crisis and heavy use of fungicides (which are similar to human medicines) in agriculture may have created the right conditions for the emergence of this drug-resistant fungus,” the NICD said in a statement, reported in Timeslive.

“We are concerned, firstly because candida auris has spread rapidly over the last 10 years in South African hospitals. Candida has potential to become resistant to multiple classes of anti-fungal medicine – also difficult to eradicate from hospital because it can become resistant to disinfectants,” said Professor Nelesh Govender, the NICD head of the centre for healthcare-associated infections, antimicrobial resistance and mycoses.

The NICD said candida auris infections can be treated with anti-fungal medicines, “although we are concerned that some strains are multidrug-resistant”.

The NICD study identifies a number of possible reasons for the infection in private-sector facilities: “We hypothesise that this might be attributable to early undetected outbreaks in this sector, inherent differences in the patient populations admitted, or structural differences in the two healthcare sectors.

“More patients with candida auris candidemia at private- sector facilities were mechanically ventilated, had prior hospitalisation, and had prior systemic antimicrobial drug therapy. Antimicrobial drug prescription behavior and differences in antimicrobial drug stewardship practices, including easier access to a broader range of anti-fungal drugs, might also play a role.

“Last, ongoing outbreaks at a few facilities might drive the higher case numbers in the private healthcare sector. The presence of a central venous catheter is a well-established risk factor for blood- stream infections. It is not surprising that central venous catheters were associated with candida auris candidemia, because the pathogen has been shown to form biofilms and adhere to polymeric surfaces.”

[link url="http://www.nicd.ac.za/wp-content/uploads/2019/07/Epidemiologic-Shift-in-Candidemia-driven-by-Candida-Auris-South-Africa-2016-2017.pdf"]NICD study[/link]
[link url="https://select.timeslive.co.za/news/2019-08-07-this-is-just-how-hard-a-deadly-bug-has-hit-private-hospitals/"]Times Select report (subscripiton needed)[/link]
[link url="http://www.702.co.za/articles/344102/the-deadly-fungus-found-in-south-african-hospitals"]702 report[/link]

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