Status:
Active
Health alert:
AL180008
Date Issued:
07 Aug 2018
Issued by:
Dr Brett Sutton, Deputy Chief Health Officer (Communicable Disease)
Issued to:
Hospitals, Laboratories and General Practitioners

Key messages

  • A Victorian man has been diagnosed with the uncommon fungal superbug Candida auris (also known as C. auris). This is the first known case of C. auris in Victoria.
  • C. auris is a fungus which can cause colonisation on the skin, or invasive infections (e.g. bloodstream or urine infections) and has caused outbreaks in many other countries, including England and the United States.
  • C. auris is of particular concern for the following reasons:
    • It causes serious infections
    • It is often resistant to anti-fungal medicines, and may be untreatable
    • It is becoming more common internationally
    • It is difficult to identify as it can be misidentified as other Candida species
    • It can spread readily in hospitals and nursing homes
  • The Department of Health and Human Services is working very closely with our health services and public health laboratories to take a 'search and destroy' approach to ensure it does not spread within health facilities or cause outbreaks.
  • Routine screening is taking place for patients who shared a ward with the affected patient.
  • It is important for laboratories and clinicians to be aware of the possibility of C. auris in high-risk patients.
  • Any confirmed cases of C. auris in patients should be notified to the Department of Health and Human Services immediately by telephone via 1300 651 160.
  • Any confirmed isolates C. auris should be forwarded to the Victorian Infectious Diseases Reference Laboratory (VIDRL) for confirmatory and sensitivity testing.

What is the issue?

A Victorian man has been diagnosed with C. auris. This is the first known case in Victoria. The infection was likely acquired during admission to a hospital in the United Kingdom.

C. auris is a major public health concern for the following reasons:

  • It causes serious infections. C. auris can cause bloodstream infections and even death, particularly in hospital and nursing home patients with serious medical problems. More than 1 in 3 patients with invasive C. auris infection (for example, an infection that affects the blood, heart, or brain) die.
  • It's often resistant to medicines. Antifungal medicines commonly used to treat Candida infections often don't work for Candida auris. Some C. auris infections have been resistant to all three types of antifungal medicines.
  • It's becoming more common. Although C. auris was just discovered in 2009, it has spread quickly and caused infections or facility outbreaks in more than a dozen countries.
  • It's difficult to identify. C. auris can be misidentified as other types of fungi unless specialized laboratory technology is used. This misidentification might lead to a patient getting the wrong treatment.
  • It can spread in hospitals and nursing homes. C. auris has caused outbreaks in healthcare facilities and can spread through contact with affected patients and contaminated surfaces or equipment. Good hand hygiene and cleaning in healthcare facilities is essential because C. auris can live on surfaces for several weeks.

The Department of Health and Human Services is working closely with the health care facility where the patient was admitted to screen any other patients who may have been in contact with the case on same ward.

Who is at risk?

People at highest risk of C. auris infection or colonisation include those with:

  • Recent overseas healthcare admissions (particularly the United Kingdom, United States, South Korea, India, Pakistan, South Africa, Kuwait, Colombia and Venezuela)
  • Diabetes mellitus
  • Recent antibiotic use (especially broad-spectrum antibiotics)
  • Recent surgery
  • Central venous catheters

Symptoms and transmission

Colonisation with C. auris is asymptomatic. Colonisation is generally on the skin, in the urine or around other indwelling devices (such as PEG tubes and central lines).

Invasive infection can present as sepsis, urinary tract infections, wound infections, ear infections or line infections. C. auris sepsis has a case fatality rate between 30% and 60%, similar to other invasive Candida infections. Most people with invasive infection have other co-morbidities.

C. auris is transmitted via person-to-person contact. C. auris is easily transmitted in health care and aged care settings. Transmission has been demonstrated to occur through medical equipment such as axillary thermometers. Outbreaks have occurred in more than a dozen countries since the organism was first discovered in 2009.

Recommendations

Clinicians and laboratories should be aware of the possibility of C. auris, especially in high-risk patients who have cultured non-albicans Candida species. Any confirmed isolates of C. auris should be forwarded to the Victorian Infectious Diseases Reference Laboratory for further confirmation and typing.

Laboratories unable to further speciate non-albicans Candida species isolates should consider forwarding these isolates from high-risk patients to the Victorian Infectious Diseases Reference Laboratory for further speciation, confirmation and typing. Further detailed guidance to laboratories will be developed as soon as possible. In the interim, US CDC provides robust guidance to laboratories.

Any confirmed cases (colonisation or infection) of C. auris in a patient should be notified to the Department of Health and Human Services immediately by telephone via 1300 651 160.

More information

Clinical information

For further information for clinicians, health care facility staff, patients and visitors and regarding screening please visit:

Disease information and advice: Candida auris

GOV.UK infectious diseases

Centers for Disease Control and Prevention

Consumer information

Better Health Channel

Contacts

For more information please contact the Communicable Disease Prevention and Control section at the Department of Health and Human Services on 1300 651 160.

 

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