Nursing Home Neglect, Low Staffing, Helping To Spread Dangerous Drug-Resistant Infection: Report

Healthcare professionals are having trouble combating potentially deadly and often drug-resistant candida auris (C. auris) infections, due to nursing home neglect and staffing problems at facilities throughout the U.S., according to a new report.

The New York Times published findings of an investigation last week, which detail how nursing home c. auris infections impacted 39 patients in just one Brooklyn facility, suggesting that the drug-resistant infection appears to be spreading rapidly due to poorly-run long-term care facilities.

Candida auris is a fungus first seen in Japan in 2009, and came to the U.S. in 2015. Since it first arrived in the U.S., the infection has spread dramatically, especially at hospitals and nursing homes.

In an April report, the U.S. Centers for Disease Control and Prevention (CDC) warned that there were 587 confirmed cases, 30 probable cases, and more than 1,000 people who tested positive for candida auris colonization since 2016, meaning the fungus is living on their body but not making them ill.

That number has increased to 800 confirmed cases, according to the New York Times report.

In New York alone, there are 396 known infection cases, and nearly 500 people are known to be carriers who have not been infected. Half of infected patients die within 90 days, according to the report.

The infections and carriers are also widespread in Chicago, among patients living on dedicated ventilator floors of nursing homes.

The report indicates that while much of the blame for the spread of c. auris has been linked to overuse of antibiotics in the past, now attention is turning to nursing homes and long-term care facilities as major vectors for the spread of the infections. It has gotten so bad, that some facilities are refusing to accept patients with the infections.

There are a number of reasons for the spread through these facilities, according to the report. Stopping its spread requires diligent infection control measures, which are difficult to maintain if facilities are understaffed or do not have the proper equipment. The situation is exacerbated as sick patients go back and forth from nursing homes to hospitals, increasing the odds they spread the infections every time.

C. Auris Infection Concerns

C.auris is not a threat to most healthy people. However, among those with weakened immune systems, the fungal infection can be serious and life threatening.

Roughly 30-60% of people who get C. auris die within 90 days. However, many of those people were already sick with other conditions, which is what made them more susceptible to the infection.

The fungus acts like a bacteria because it can stick to and live on surfaces in healthcare environments, including medical equipment, light switches, mattresses, bed rails, and the hands of doctors and healthcare staff.

Infections begin with a fever and chills, which can make it hard to diagnose early.

Most infections respond to echinocandins, a type of anti fungal medication. However, some strains are resistant to the main classes of drugs. This requires doctors to treat patients with multiple types of medication at much higher doses or all three classes of drugs at the same time.

The CDC first warned the public about C. auris in 2017, as reports of the infection became more frequent, especially among hospitalized patients. As confirmed cases of the infection increased to more than 122 people, the CDC issued warnings regarding the danger C. auris poses to the country.

Most cases in the U.S. were reported in New York City, New Jersey, and Chicago, but other states have also confirmed infections.

Patients can follow certain precautions to prevent candida auris infections, including frequent hand washing and requesting their doctor wash hands before examining them. However, healthcare facilities must change the way they clean and disinfect patient rooms in order to prevent infections from spreading rapidly through hospitals.

The CDC also recommends patients with C. auris be kept in the same room to prevent spreading it to other patients and to help keep extensive cleaning measures needed following C. auras infection to only certain rooms.