Emerging spread of new fungal species poses risk for healthcare settings in the EU/EEA

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The rise in Europe of Candida auris infections, a difficult-to-control fungus, is of concern. The fungus spreads easily in healthcare settings, can cause invasive infections, and is also associated with resistance to multiple classes of anti-fungal medication. Difficulties with laboratory identification, and lack of awareness of this new Candida species might result in transmission and outbreaks remaining unnoticed.

The first discovered case of infection of the fungus was reported in 2009 in Japan. Since then, there have been several outbreaks in five continents, making the emerging spread of the fungus a global public health issue within just a few years. During 2013–2017, 620 cases of Candida auris were reported in the European Union/European Economic Area (EU/EEA).

“There is a need to raise awareness in European healthcare facilities for them to adapt their laboratory testing strategies, and implement enhanced control measures early enough to prevent further hospital outbreaks” says Dominique Monnet, Head of the Antimicrobial Resistance and Healthcare-associated Infections Disease Programme at ECDC. “The occurrence of new outbreaks can be expected. It is therefore of concern that some countries lack national laboratory reference capacity for mycology, or have no information on Candida auris cases available at national level”.

Candida auris can cause invasive infections in patients, especially in those who are suffering from severe underlying diseases and suppressed immune systems. Candida auris can survive on surfaces for weeks and requires special disinfectants, as some of the disinfectants commonly used in hospitals are not effective. The fungus is associated with resistance to fluconazole, a common antifungal medication, and multidrug-resistant isolates have also been identified.

Early detection of the fungus is necessary for preventing further cases and outbreaks. However, identification of Candida auris requires specialised laboratory methodology as traditional identification methods may lead to misidentification. Due to a lack of laboratory capability for routine detection and surveillance in some EU/EEA countries, recognition of Candida auris introduction to a healthcare facility might be delayed until spread has already occurred.

ECDC issued a Rapid Risk Assessment on 23 April 2018, which contains options for response to EU/EEA countries on possible measures to reduce identified risks, including laboratory detection, infection control measures as well as improvement of surveillance and preparedness.