Atlanta—Pharmacists should be aware of a growing threat from Candida auris. Cases and transmission of the fungal infections have shot up in recent years, with an especially dramatic increase in 2021, according to a new report from CDC researchers.

What makes the situation especially concerning is the rise in echinocandin-resistant cases, according to the report in Annals of Internal Medicine. Echinocandins are considered first-line therapy for invasive Candida infections, including C auris.

“These findings highlight the need for improved detection and infection control practices to prevent spread of C auris,” the authors emphasized, pointing out that C auris has been spreading in the U.S. since it was first reported in 2016.

The CDC advises that 3,270 clinical cases and 7,413 screening cases of C auris were reported in the U.S. through December 31, 2021. “The percentage increase in clinical cases grew each year, from a 44% increase in 2019 to a 95% increase in 2021,” according to the article. “Colonization screening volume and screening cases increased in 2021 by more than 80% and more than 200%, respectively.”

From 2019 to 2021, the researchers point out, 17 states identified their first C auris case. “The number of C auris cases that were resistant to echinocandins in 2021 was about 3 times that in each of the previous 2 years,” they added.

A limitation of the study is that the Identification of screening cases depends on screening that is inconsistently performed and based on need and available resources. Screening is not conducted uniformly across the U.S., however, so the true burden of C auris cases might be underestimated.

Another recent study published in the Infection and Drug Resistance journal points out that the primary antifungal drugs available to treat Candida infections are classified into four groups.

“The first are azoles, such as fluconazole, itraconazole, isavuconazole, posaconazole, and voriconazole; whilst the second group are polyenes, such as amphotericin B,” wrote researchers from Universidad de Guanajuato in Mexico. “The echinocandins anidulafungin, caspofungin, and micafungin are in the third group; and finally, in group four is the pyrimidine analog flucytosine, which is not licensed for monotherapy in Candida infection because the pathogen easily develops resistance.”

The authors caution that the group of azoles has been widely used against Candida infections but has been plagued by increasing antifungal resistance.

The report adds that C auris has intrinsic resistance to fluconazole, voriconazole, amphotericin B, and echinocandins.

“The treatment options for patients with infections due to C auris are complicated; however, the use of echinocandins or amphotericin B is the clinical recommendation, with the risk that the different isolates show a variable susceptibility,” the researchers noted.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

 
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