Healthcare-associated fungal outbreaks: New and uncommon species, New molecular tools for investigation and prevention

Abstract

Outbreaks of healthcare-associated fungal infections have repeatedly been described over recent years, often caused by new or uncommon species. Candida auris, a recently described multidrug-resistant yeast species, is certainly the most worrisome species having caused several severe healthcare outbreaks of invasive infections, on four continents. Also, large nosocomial outbreaks due to uncommon fungal species such as Exserohilum rostratum and Sarocladium kiliense, were both linked to contamination of medical products, however the source of another outbreak, caused by Saprochaete clavata, remains unresolved. Furthermore, these outbreaks identified new populations under threat in addition to those commonly at risk for invasive fungal infections, such as immunosuppressed and intensive care unit patients. All of these outbreaks have highlighted the usefulness of a high level of awareness, rapid diagnostic methods, and new molecular typing tools such as Whole Genome Sequencing (WGS), prompt investigation and aggressive interventions, including notification of public health agencies.This review summarizes the epidemiological and clinical data of the majority of healthcare-associated outbreaks reported over the last 6 years caused by uncommon or new fungal pathogens, as well as the contribution of WGS as support to investigate the source of infection and the most frequent control measures used.

Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors

“…Antifungal drug resistance is a matter of concern. In the current study, the drug with the highest resistance rate was itraconazole, and more than one‐third of the C. glabrata was not sensitive to it.…”

Epidemiology, clinical characteristics, resistance, and treatment of infections by Candida auris

“…Of note, most reported infections involved critically ill patients [ 15 , 18 ]. Moreover, difficulty in microbiological identification [ 19 , 20 ], high virulence [ 21 – 23 ], multi-drug resistance profile [ 24 , 25 ], and rapid global spread with several reported outbreaks ([ 11 , 26 , 27 ]; ( https://www.cdc.gov/fungal/diseases/candidiasis/tracking-c-auris.html ); [ 28 ]) lead the healthcare and scientific communities to consider C. auris as one of the most serious emerging pathogen that critical care physicians should be aware of.…”

Detection and Control of Fungal Outbreaks

“…The second group of fungal outbreaks is related to hospital care and has been increasingly reported during the past two decades, likely as a result of the increase in at-risk populations [ 13 ]. The sources of healthcare-associated outbreaks include construction near or renovation of healthcare facilities, contamination of water and ventilation systems, medicines and medical devices, and gaps in infection prevention measures [ 9 – 12 , 14 , 15 ]. An increasingly reported cause of fungal outbreaks is the emergence of novel resistant pathogens within hospital environments, clearly exemplified by the unprecedented emergence of Candida auris , as well as increasing incidence of previously rare resistant species like Candida krusei and Diutina rugosa [ 16 – 19 ].…”