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Why CDC Warns Antibiotic Resistant Fungal Infections Are An Urgent Threat To Health – Raw Story

In 2013, I took care of a gentleman who underwent surgery for what all his doctors, including myself, considered to be liver cancer. Surgery revealed that the disease was a rarer but benign tumor, not cancer. As you can imagine, he and his family were pleased and relieved.

However, two weeks after this operation, he developed a liver abscess – a capsule tissue infection. The surgeons operated to remove the abscess. Two days later, the test results revealed that the abscess was caused by a fungus called Candida which was resistant to echinocandins, our most powerful cure for this fungus.

The patient underwent multiple surgeries and then received various antibiotics, but his abscess continued to grow. He died four weeks after the first abscess surgery. The cause of death was sepsis due to its echinocandin-resistant Candida infection, which was rare in the United States at the time. This tragic case showed me first and foremost the devastating impact of drug-resistant fungal infections.

Over the years, I have cared for over a dozen patients who died due to antibiotic-resistant fungal infections. On November 1

3, 2019, the Centers for Disease Control and Prevention released a report on threats to antibiotic resistance in the United States, warning that drug-resistant fungi have become major public health issues.

A new report revealed that 18 microorganisms cause nearly 3 million antibiotic resistant infections and 35,000 deaths a year. For the first time, this report includes several antibiotic resistant mushrooms: Candida auris other drug resistant Candida (as in my patient above) and azole resistant Aspergillus fumig . These resistant mushrooms are particularly threatening as only three classes of antifungal medicines are currently available.

Antibiotic Resistant Mushrooms?

In recent years, we have heard a great deal about the public health crisis of antibiotic-resistant bacteria, but less attention is paid to antibiotic-resistant fungi. In part, this is because fungi have become a common cause of the disease only in the last 30 years. During this time, the risk of serious fungal infections is increasing as more and more people suffer from a weakened immune system stemming from enlarged bone marrow and organ transplants, new drugs to treat cancer and other diseases and complex surgeries. The widespread use of more powerful antibiotics for the treatment of resistant bacterial infections also contributes, creating less competition for the growth of fungi in human tissues.

Candida auris is cultivated in petri dishes. Some strains are resistant to the three main classes of antifungal medicines.
Shawn Lockhart / CDC / NCEZID; DFWED; MDB

Fungi include yeasts that grow as spherical cells; and molds that grow as elongated tubular cells. Yeast and molds are more genetically related to humans than bacteria. Therefore, it is difficult to develop antibiotics that attack fungi without damaging human cells.

Candida are yeasts that usually cause skin rashes, urinary tract infections and vaginal infections. However, they are also the third leading cause of sepsis and other life-threatening infections in US hospitals.

Candida auris was discovered in 2009, but was almost never found in medical conditions until 2015, when multiple infections suddenly appeared on multiple continents. It is already one of the five most urgent threats to the CDC for two main reasons.

First, it exhibits a high level of antifungal resistance. Ninety percent of the strains are resistant to fluconazole, the frontal antifungal in many countries; 30% are resistant to two antifungal classes; and between 3% and 5% for all antifungal medicines.

Another reason that the CDC is concerned about C. auris is that it has the unique ability to spread from person to person through contact with the hands and clothing of healthcare professionals or contaminated medical devices. It also persists beyond humans in health settings and causes large, long-standing infectious outbreaks. C. auris is a remarkably healthy organism that can survive the standard methods of disinfection, high temperatures and saline solutions that kill other germs.

Since the first US case in 2016, S. auris has caused more than 800 infections in 13 countries. The CDC and local health departments are currently working to manage multiple health care outbreaks. It is not clear why this fungus has emerged now, although climate and other environmental changes may have played a role. Similarly, it is unclear how wide C. auris will expand in the United States or globally.

This is not only C. auris we should worry about

Aspergillus fumigatus grown from a soil sample.
Dr. David Midgley., CC BY

Other fungi resistant to drugs in the Candida family are also considered "serious threats" by the CDC. These strains cause more than 34,000 infections a year, more than caused by C. auris but are less likely to spread from person to person and cause outbreaks. However, deeply invasive C. auris and other drug resistant Candida infections are similar in severity, resulting in the death of 40% of patients.

Another dangerous type of fungus that the CDC releases is Aspergillus fumigatus, – a mold found in soil and vegetation that releases spores that most people inhale daily without problems. However, people with weakened immune systems – especially cancer patients or transplant recipients – can develop lung or other organic infections that kill between 50% and 75% of infected patients.

Azole antifungal drugs are the only drugs that kill A. fumigate without causing serious side effects. Azoles are also widely used in agriculture. Azo-resistant A. Fumigatus infections are the most common in Europe, where they are associated with agricultural and patient use. Although these infections are still rare in the United States, the CDC has put A. fumigatus azole-resistant on its "resistance watch list" because azole use is so widespread in this country and vulnerable populations of patients are large. Dealing With Antibiotic Resistant Fungi Requires Many Strategies

How Does the US Fight Antibiotic Resistant Fungi? The CDC and health departments are leading in the monitoring of resistance and, in the case of C. auris outbreaks and prevention. Detention involves the rapid and accurate diagnosis of C. auris infections and the use of hospital gowns, gloves, equipment and cleaning materials that reduce the likelihood of fungal spread.

Various US government agencies have funded research leading to new antifungal drugs and improved diagnostic tests.

Organizations that evaluate the quality of public health care are now requiring healthcare facilities to have antibiotic management programs that reduce inappropriate ones. prescribing and developing resistance.

Efforts are also being made to control the use of antibiotics in agriculture and animals, since resistance cannot be overcome by focusing solely on human medicine. The CDC and other US agencies are working closely with international partners as antibiotic-resistant germs do not recognize geographical boundaries. Finally, the most important first step to dealing with a problem is recognizing it, which is why the CDC report on threats of antibiotic resistance is so important.

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Cornelius (Neal) J. Clancy, Assistant Professor of Medicine and Director of Mycology, University of Pittsburgh

This article is reprinted by The Conversation under a Creative Commons license. Read the original article.

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