Pan-Resistant Candida auris Identified in Texas

In January 2021, Candida auris became a Texas notifiable condition with required isolate submission to the DSHS Laboratory in Austin. Since it became reportable, seven cases of C. auris have been reported in Texas residents. Two of these cases were identified as resistant to all three classes of antifungal drug. These are the first cases of pan-resistant C. auris identified in Texas. This Health Advisory is intended to provide recommendations regarding laboratory identification methods, treatment options and infection control recommendations to mitigate C. auris transmission.

About Candida auris

Candida auris is a fungus that may cause serious illness for those it infects. C. auris can cause invasive infections, including bloodstream infections, which may result in death, particularly in hospital and long-term care patients. C. auris is a public health threat because it is often multidrug-resistant, is difficult to identify, and can persist on surfaces in healthcare environments, resulting in the spread of C. auris among patients in healthcare facilities. Patients exposed to C. auris may remain colonized for a long time, putting them at risk for a future C. auris infection and further spreading the fungus.  

Laboratory Identification

If C. auris infection is suspected, ask the testing laboratory to keep all isolates. C. auris can be misidentified in the laboratory when using traditional phenotypic methods for yeast identification such as VITEK 2 YST, API 20C, BD Phoenix yeast identification system, and MicroScan. CDC provides guidance on common misidentifications by identification method.

All C. auris isolates and any Candida isolates that may be misidentified or cannot be identified may be referred to the DSHS Laboratory.  

Infection Control Recommendations

To mitigate transmission of C. auris in healthcare settings, implement the following recommendations for inpatient settings:

• Place the patient in a single-patient room and use Standard and Contact Precautions.
• Emphasize adherence to hand hygiene.
• C. auris can persist on surfaces in healthcare environments. Clean and disinfect the patient care environment (daily and terminal cleaning) and patient care equipment with an Environmental Protection Agency (EPA)-registered hospital-grade disinfectant effective against C. auris or Clostridium difficile spores (List K).
• Use dedicated equipment, whenever possible. Clean and disinfect any reusable equipment that is used on the infected/colonized individual after each use. Shared equipment (e.g., ventilators, physical therapy equipment) should also be cleaned and disinfected before use by another patient.
• Flag the patient’s Electronic Medical Record so appropriate infection control measures including contact precautions can be implemented.
• Upon patient transfer, inform the accepting facility of the C. auris colonization or infection history and the level of isolation needed.
• Screen close healthcare contacts of newly identified patient(s) with C. auris infection or colonization for presence of colonization.  

The CDC has developed infection control recommendations and educational materials for healthcare settings, patients and family members. View additional recommendations.

Treatment

• Multidrug-resistance is common with C. auris. Most strains of C. auris found in the United States have been susceptible to echinocandins. Patients on antifungal treatment should be carefully monitored for clinical improvement and follow-up cultures with susceptibility testing should be conducted.
• CDC has developed specific treatment guidelines for adults, infants, and neonates.
• CDC does not recommend treatment of C. auris cultured from noninvasive sites when there is no evidence of infection.   

For more information, healthcare providers can contact their local health department.