Fungal Pathogens with Sticking Power: Candida auris Is Here to Stay

Unlike some other emerging pathogens, such as Zika or even Mpox (previously Monkeypox), Candida auris (C. auris) is not going anywhere any time soon. According to the Centers for Disease Control and Prevention’s U.S. C. auris tracking data, from December 2021 to November 2022, there were 2,314 clinical cases and 5,612 screening cases. For comparison, in 2020, there were just 755 clinical cases and 1,309 screening cases.¹ What makes C. auris different than some of these other emerging pathogens is its resistance to antimicrobial medication and its resiliency in our healthcare environments. In many ways, it is a yeast that behaves more like a bacteria.

Back in December 2021, my colleague and CloroxPro Principal Infection Preventionist, Doe Kley, highlighted The Problem(s) with Candida auris. The concerns she highlighted are as true today as they were over a year ago:

1. Surface transmission is the primary route by which C. auris is spread and once it gets a foothold in a facility, it can be very difficult to eradicate.²
2. Colonized patients (i.e., a person is carrying C. auris but does not have symptoms of an infection) can carry the fungi for a long time, perhaps indefinitely, and can spread C. auris to others in healthcare settings. One recent study demonstrated that a colonized patient can re-contaminate environmental surfaces within a patient’s room within hours despite regular cleaning and disinfection.³
3. High morbidity and mortality for those that become infected with limited treatment options due to antifungal resistance.²

The growing awareness over emerging fungal pathogens, like C. auris, is gaining more and more attention. Several infectious disease experts are already predicting that the next major pandemic will be caused by a fungal infection. These fears are not isolated to the United States. The concern globally has triggered the World Health Organization (WHO) to release a Fungal Priority Pathogen List in October 2022. This list is the first global recognition of the ongoing threat these sticky pathogens present and is meant to help drive research, policy interventions, and public health programs around preventing fungal infections and the development of antifungal resistance.⁴ The WHO list is broken down into three main priority groups of fungi: critical, high and medium.

C. auris is unsurprisingly listed in the Critical Priority Group.

Other fungi listed in the Critical Priority Group include:

• Cryptococcus neoformans — C. neoformans is an environmental fungi that infects primarily immunocompromised individuals. The disease it causes, cryptococcosis is acquired through the respiratory route when fungi are inhaled from the environment.⁵
• Aspergillus fumigatus — A. fumigatus is an environmental mold that can infect vulnerable individuals and cause the disease, aspergillosis. Antifungal resistant A. fumigatus (particularly azole-resistant invasive aspergillosis) is of high concern as it can be life-threatening with a very high mortality.⁶
• Candida albicans — C. albicans is a yeast which can be part of the healthy human microbiome but may also cause invasive candidiasis infections.⁷

CloroxPro is committed to meeting this fungal threat head-on by providing products that can help reduce environmental contamination on healthcare surfaces and protect vulnerable patients in and outside the four walls of the hospital.

The following CloroxPro products are registered with the United States Environmental Protection Agency (EPA) to be effective to kill Candida auris also known as C. auris on hard, nonporous surfaces when used as directed:

• Clorox Healthcare® Hydrogen Peroxide Wipes (2 minute contact time)
• Clorox Healthcare® Hydrogen Peroxide Cleaner (2 minute contact time)
• Clorox Healthcare^® Bleach Germicidal Disinfectant Wipes (3 minute contact time)
• Clorox Healthcare^® Bleach Germicidal Disinfectant Cleaner (3 minute contact time)
• Clorox Healthcare^® Spore¹⁰ Defense™ Cleaner Disinfectant (3 minute contact time)

All of the CloroxPro® products listed above are on List P, the EPA list of antimicrobials products registered for claims against C. auris. To learn more, please visit List P.

References

<sup>1. Centers for Disease Control and Prevention. Candida auris: Tacking Candida auris. [Internet]. [Cited 2023 February 6]. Available from: https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html
2. Centers for Disease Control and Prevention. Candida auris: Candida auris. [Internet]. [Cited 2023 February 6]. Available from: https://www.cdc.gov/fungal/candida-auris/index.html
3. Sansom S, Gussin G, Singh R, Bell P, Jinal E, et al. Multicenter evaluation of contamination of the healthcare environment near patients with Candida auris skin colonization. Antimicrobial Stewardship & Healthcare Epidemiology. 2022: 2(S1), S78-S79.
4. World Health Organization (WHO). WHO fungal priority pathogens list to guide research, development and public health action. 25 October 2022 Report. [Internet]. [Cited 2023 February 6]. Available from: https://www.who.int/publications/i/item/9789240060241
5. Centers for Disease Control and Prevention. Fungal Diseases: C. neoformans Infection. [Internet]. [Cited 2023 February 6]. Available from: https://www.cdc.gov/fungal/diseases/cryptococcosis-neoformans/index.html
6. Centers for Disease Control and Prevention. Fungal Diseases: Aspergillosis. [Internet]. [Cited 2023 February 6]. Available from: https://www.cdc.gov/fungal/diseases/aspergillosis/index.html
7. Centers for Disease Control and Prevention. Fungal Diseases: Candidiasis. [Internet]. [Cited 2023 February 6]. Available from: https://www.cdc.gov/fungal/diseases/candidiasis/index.html</sup>