Drug-Resistant Candida Auris Fungus Spreading Globally, Posing Serious Threat

A drug-resistant fungus, Candida auris, is spreading in hospitals and care facilities worldwide, including Israel, raising significant health concerns. The fungus can be carried by individuals without symptoms, with tests initially showing normal results, only for the fungus to reappear later. In severely ill patients, if Candida auris enters the bloodstream, it can become life-threatening.

In the United States, the Centers for Disease Control and Prevention (CDC) reported 4,523 cases in 2023, a 50% increase from the previous year and nearly a tenfold rise since 2019. A major concern is the fungus's resistance to antifungal medications, particularly one of the three main classes of drugs. Infections caused by resistant strains have a mortality rate between 29% and 62%.

Professor Ronen Ben-Ami, head of infectious diseases at Tel Aviv's Ichilov Hospital, has been studying Candida auris for over a decade. He noted that this fungus differs from common Candida species, typically causing infections in patients post-complex surgeries, organ transplants, or in intensive care. "Previously, Candida did not cause hospital outbreaks," Prof. Ben-Ami stated, recalling the first encounter with the phenomenon in 2014 at Ichilov Hospital, where four patients were diagnosed with Candida auris bloodstream infections between May and October. A similar case was recorded at Wolfson Hospital in Holon in April 2015.

Prof. Ben-Ami explained that the fungus can survive on human skin and transmit easily between patients, spreading through hospital rooms and wards. A significant surge in cases occurred during the COVID-19 pandemic, with a notable increase in Israel in 2021, primarily around COVID-19 wards. While the situation has since stabilized, localized outbreaks persist, and many carriers are now found in long-term care facilities. Hospitals are implementing screening tests to identify carriers before infections develop and to halt transmission.

Distinguishing between being a carrier and having an active infection is crucial. Carriers may be asymptomatic, while active infections present with fever, inflammation, and organ system dysfunction, potentially leading to septic shock and death in severe cases. The limited number of effective antifungal drugs, compared to antibiotics for bacteria, exacerbates the challenge. Although most infections are currently treatable as Candida auris usually remains sensitive to at least one or two classes of antifungals, strains resistant to all drugs are emerging. Researchers are hopeful about new drugs, with one currently in clinical trials showing promise.

Prof. Ben-Ami emphasized that not all Candida infections are dangerous, with oral, skin, or vaginal infections typically being treatable and causing discomfort rather than posing a serious threat, primarily affecting severely ill or immunocompromised individuals. He advised that even if a relative in the hospital is identified as a carrier, visitors should consult with the medical team for specific precautions and continue visiting, adhering to safety measures and medical staff instructions.