The first cases of
Candida auris
in the largest hospital in the Liguria region (northern Italy) were detected in 2019. Since then, this potentially deadly fungus for humans has remained uncontrolled, with more than 500 cases to date, adding new every month and resisting the treatments that are used against it.
This is how a study that has just been published in the journal
Eurosurveillace
describes it, which serves to show how difficult it is to stop the spread of this organism in hospitals, classified last year as a "pathogen of critical interest" by the World Health Organization.
The fungus is relatively new to humans.
A cousin of
Candida albicans
(which causes a very common sexually transmitted disease), it was discovered in 2009 in Japan and, since then, it has been appearing in other parts of the world with no apparent relationship to the first outbreak.
It can be transmitted to humans through the skin, through contact with contaminated surfaces, and its ideal breeding ground is hospitals, where all cases have been described up to now.
There they find very debilitated patients, often immunosuppressed, where they colonize the pathways through which they receive drugs, and are introduced into their blood, forming candidemia, the most serious infection they cause.
Mortality can exceed 50%.
After detecting a few cases in 2019, the following year the fungus multiplied in the Liguria hospital, which in the last quarter of 2020 had counted more than fifty.
Since then, the figure has remained more or less stable, with some ups and downs, despite the fact that all prevention, disinfection and patient isolation measures have been implemented.
"The most interesting thing about the article is that it demonstrates the development of resistance due to prolonged exposure to echinocandins [main drugs for this fungus] and emphasizes the importance of early detection and improvement of antimicrobial use optimization programs," he points out. Ana Alastruey-Izquierdo, researcher at the Carlos III Health Institute (ISCIII).
The case reminds this expert of the one that began in 2016 at the Hospital de la Fe in Valencia, the largest hospital outbreak of this fungus in the world, which has already reported more than a thousand cases and continues to do so, although it has managed to contain it in less than a dozen infections a year, as Javier Pemán, head of its mycology unit, explained to EL PAÍS.
There has been no official record since then, since the infections are not mandatory to report.
The Eurosurveillance
magazine itself
made a count at the end of 2022 (with data from 2013 to 2021) that raised the number of infections in Europe to 1,813, of which the vast majority (1,377) were registered in Spain, almost all of them in the hospital of Faith. Experts are convinced that they are grossly underestimated.
“It is very important to detect the fungus as soon as the first case appears, start contact precautions (isolate the patient if possible), carry out a contact study to rule out the presence of more cases and use the appropriate disinfectants to prevent it from establishing itself. in the hospital environment.
I believe that the delay in the detection of the first cases has made Spain an endemic region for
Candida auris
in which there have been cases in several centers since 2016, while in other parts of Spain there have been cases, but they have not developed outbreaks”, says the ISCIII researcher.
Microscope image of 'Candida auris'. BSIP / Universal Images Group / getty
Episodes like the Italian show the enormous difficulty of tackling it when it is no longer isolated cases.
“It seems that
Candida auris
has a special ability to colonize the hospital environment and once it is established in a center it is difficult to eliminate it.
And it shows that we still do not have the tools to handle this situation, despite the fact that much more is known about this species now than in 2016”, adds Alastruey-Izquierdo.
Rafael Ortí Lucas, president of the Spanish Society of Preventive Medicine, Public Health and Health Management, assures that in hospitals like the one where he works (the Valencia Clinic) they have managed to stop quickly with these protocols for rapid detection, disinfection and isolation.
An added difficulty is that the fungus does not respond to some of the usual disinfectants (such as those used in hydroalcoholic gels) and it is necessary to use bleach.
It is "very tough", in the words of Julio García, spokesman for the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC).
In his opinion, the covid crisis has served as a breeding ground to multiply the presence of this fungus in hospitals, thanks to the large number of patients who have gone through the ICUs and the fact that the gaze was very focused on the coronavirus.
More and more fungal infections
García is "concerned" about the proliferation of this fungus and others that may come in the future.
Because the most accepted hypothesis so far is that
Candida auris
has proliferated thanks to climate change.
It is based on the same premise as the apocalyptic series
The last of us
(although without such dramatic consequences, for the moment): they are organisms that find it very difficult to grow inside the human body, given its high temperature, but global warming may be promoting adaptations and making it easier for them to grow at 37ºC (organism temperature).
This means that "more and more fungi have the capacity to infect," according to Alastruey-Izquierdo.
The researcher points out that not all of them have the characteristics of
Candida auris
in terms of resistance to antifungals and disinfectants and the ability to spread.
"Although the threat is there, I don't think we should be alarmed today."
She points out that the main problem is that fungi, unlike bacteria and viruses, have eukaryotic cells, like humans, and therefore it is "much more difficult" to find treatments that are not toxic to us.
“Right now we only have four families of antifungals capable of treating serious infections in humans,” she adds.
Alastruey-Izquierdo calls for more resources to develop new therapies, since the percentage of the infectious disease research budget dedicated to fungal infection in the world is less than 1.5%.
"There is also a significant lack of awareness and lack of availability and access to appropriate diagnoses and treatments throughout the world, probably in part as a result of lack of funding," he settles.
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