Albany, NY—The CDC is sounding a warning after three New York patients were found to be ill with pan-resistant Candida auris, an emerging yeast that often  responds to a range of antifungal medications.

Researchers from the New York State Department of Health said no transmission of the pan-resistant isolates was found in patient contacts or the facility environments. The report was published recently in the CDC’s MMWR publication.

“Three years after the first identification of C. auris in New York, pan-resistant isolates remain rare,” the authors write. “Continued surveillance for C. auris, prudent antifungal use, and susceptibility testing for all C. auris clinical isolates (especially after patients have been treated with antifungal drugs) are needed.”

The CDC points out that C auris is a globally emerging yeast that causes outbreaks in healthcare settings and is often resistant to one or more classes of antifungal medications. Cases of C auris with resistance to all three classes of commonly prescribed antifungal drugs, designated as pan-resistance, have been reported in multiple countries but, until now, not in the United States.

C auris has been identified in the United States since 2016, with the largest number (427 of 911) of confirmed clinical cases reported as of October 31, 2019, in New York, where the yeast infection was first detected in July 2016.

The report notes that, as of June 28, 2019, 801 patients with C auris were identified in New York, based on clinical cultures or swabs of skin or nares obtained to detect asymptomatic colonization. Three were determined to have pan-resistant C auris that developed after receiving antifungal medications, including echinocandins, a class of drugs that targets the fungal cell wall.

Researchers point out that all three patients had multiple comorbidities and no known recent domestic or foreign travel.

“Although extensive investigations failed to document transmission of pan-resistant isolates from the three patients to other patients or the environment, the emergence of pan-resistance is concerning,” they write. “The occurrence of these cases underscores the public health importance of surveillance for C. auris, the need for prudent antifungal prescribing, and the importance of conducting susceptibility testing on all clinical isolates, including serial isolates from individual patients, especially those treated with echinocandin medications.”

Researchers explain that echinocandins are the treatment of choice for C auris infections, especially since most of the New York strains are fluconazole-resistant. “However, because of the potential for development of resistance, patients on antifungal treatment for C. auris should be monitored closely for clinical improvement, and follow-up cultures should be obtained,” they add. “Repeat susceptibility testing should also be conducted, especially in patients previously treated with echinocandins. Consultation with an infectious disease specialist is recommended, especially given the possibility of emergence of pan-resistance.”

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