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A medical illustration of Candida auris from the CDC's "Antibiotic Resistance Threats in the United States, 2019." Credit: Stephanie Rossow/CDC

CDC officials are concerned about a strain of the Candida auris fungus that's resistant to all drugs and appears to have spread in small clusters in health care settings, rather than in individuals who had taken antifungals.

Why it matters: "The concern is that it could spread to any of the patients who are at high risk, not just the ones who've been treated before — and that the population who could acquire these potentially untreatable infections could be much larger," Meghan Lyman, medical officer in the CDC's Mycotic Diseases Branch, tells Axios.

Background: There are only three main classes of drugs to fight invasive fungal infections: azoles, polyenes and echinocandins. There has been growing evidence of C. auris becoming resistant to one or two of these drugs, with echinocandins usually remaining effective.

  • But the latest clusters were resistant to all three.
  • The fact that C. auris can colonize skin or surfaces, and often doesn't respond to traditional ammonia cleaners, has caused some health care facilities to rip out entire units after infection. The EPA recently issued a list of approved cleaning agents to try and combat this.
  • However, there had only been a few isolated cases of known pan-resistant C. auris in the U.S. before 2021, all in patients who had susceptible strains and had developed resistance after taking antifungals, Lyman says.

What's happening: As detailed in the CDC's MMWR report Thursday, small, independent clusters of pan-resistant C. auris infections were found from January to April this year: three in D.C. (out of 101 C. auris cases) and two in Texas (out of 22 cases).

  • "These clusters are the first time where we're really concerned that it's spreading," Lyman says, as none of the patients had been exposed to echinocandin before.
  • "It's most likely spread through contaminated health care surfaces, " she says, which can include anything from beds, to mobile equipment, to shared PPE, to the hands from a health care worker if not properly sanitized.
  • Plus, not only does the CDC believe C. auris is underreported. But the rising number of known infections overall means there's a "greater chance of having more resistance pop up," Lyman says.

What's next: If a hospital, nursing home or long-term care facility suspects C. auris, they should reach out to their local health department for guidance, Lyman says.

  • While these pan-resistant infections are untreatable with the three classes of antifungals, there are investigational drugs looking at combination therapies and a new class of antifungals is in the pipeline, which could be "very exciting," she adds.

Go deeper: The growing threat of drug-resistant, invasive fungi

Go deeper

Jul 22, 2021 - Health

COVID cases are up 55% across the U.S.

Expand chart
Data: CSSE Johns Hopkins University; Note: Rhode Island and Iowa data is from CDC and from July 12-July 19; Map: Axios Visuals

Coronavirus infections are rising dramatically all over the U.S. as the highly contagious Delta variant spreads.

The big picture: Some “breakthrough” infections are happening to vaccinated people, but this rising tide of cases and hospitalizations is mainly a threat to those who aren’t vaccinated. And in some parts of the country, most people aren’t vaccinated — so the virus can still do serious damage.

Democrats release full text of Biden's $3.5T reconciliation package

House Speaker Nancy Pelosi. Photo: Alex Wong/Getty Images

House Speaker Nancy Pelosi (D-Calif.) on Friday unveiled the full text of President Biden's $3.5 trillion social spending package.

Why it matters: Democrats are racing to finish negotiations and get the bill on the floor as soon as possible so Pelosi can fulfill her promises to both House centrists and progressives about the timing and sequencing of passing the party's dual infrastructure packages.

Biden pushes massive economic plan despite "stalemate"

President Biden speaking from the White House on Sept. 24. Photo: Al Drago/Bloomberg via Getty Images

President Biden on Friday urged congressional Democrats to overcome differences surrounding his multi-trillion-dollar economic proposal but said he's still confident it will pass.

Why it matters: It's currently unclear how the $1.2 trillion bipartisan infrastructure bill and the $3.5 trillion reconciliation package will move forward with moderate and progressive Democrats in disagreement over critical portions of the legislation.

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