First drug-resistant fungal infections cases identified in US

A serious and sometimes fatal fungal infection, that is often resistant to antifungal drugs and tends to occur in hospitalised patients, has been identified in 13 people in the US, according to a new report.
Seven of the cases occurred between May 2013 and August 2016 and are described today in Centres for Disease Control and Prevention's (CDC) Morbidity and Mortality Weekly Report (MMWR).
The other six cases were identified after the period covered by the report and are still under investigation.
The report is the first to describe US cases of C auris infection.
In June 2016, CDC issued a clinical alert describing the global emergence of C auris and requesting that laboratories report C auris cases and send patient samples to state and local health departments and CDC.

"We need to act now to better understand, contain and stop the spread of this drug-resistant fungus," said CDC Director Tom Frieden.

"This is an emerging threat, and we need to protect vulnerable patients and others," Frieden said.
Among the seven cases detailed in the report, patients with C auris were reported in four US states: New York, Illinois, Maryland and New Jersey.
All of the patients had serious underlying medical conditions and had been hospitalised an average of 18 days when C auris was identified.
Four of the patients died; it is unclear whether the deaths were associated with C auris infection or underlying health conditions.

In two instances, two patients had been treated in the same hospital or long-term-care facility and had nearly identical fungal strains.
These findings suggest that C auris could be spread in healthcare settings.
Six of the seven cases were identified through retrospective review of hospital and reference laboratory records.
Identifying C auris requires specialised laboratory methods because it can easily be misidentified as another type of Candida infection, in which case patients may not receive appropriate treatment.
Most of the patient samples in the current report were initially misidentified as another species of Candida.
Most of the C auris strains from US patients (71 per cent) showed some drug resistance, making treatment more difficult.

Samples of C auris strains from other countries have been found to be resistant to all three major classes of antifungal medications.
However, none of the US strains in this report were resistant to all three antifungal drug classes. Based on laboratory testing, the US strains were found to be related to strains from South Asia and South America.
However, none of the patients travelled to or had any direct links to those regions. Most patients likely acquired the infections locally.