Candida auris is silently ravaging nursing homes across New York, New Jersey and Illinois, leading to patient deaths and no easy solution to stop the spread of the bacteria. Also known as C. auris, Candida auris is a highly contagious, antibiotic-resistant fungus that has infected nearly 800 people since it arrived in the United States four years ago. New York has seen 331 cases. Half of patients die within three months.
Referring to nursing homes as “cauldrons” teeming with bacteria, Dr. Tom Chiller of the Centers for Disease Control and Prevention (CDC) also noted that New York is “ground zero” for drug-resistant fungi, including Candida auris. One home that has been especially hard-hit by this crisis in Palm Gardens Center for Nursing and Rehabilitation in Brooklyn. At the peak of the infection, 38 residents were plagued with Candida auris. That number dropped only after some residents died. The problem is exacerbated by nurses and staff, who have allegedly moved about without the requisite masks, gloves, and gowns. As Palm Gardens has many residents on ventilator support, the facility is especially vulnerable. Ventilators increase the risk of infection. For example, according to the New York Times, “In Chicago, half of patients living on dedicated ventilator floors in the city’s skilled nursing homes are infected with or harboring C. auris in their bodies…”
Much more than short-term acute care hospitals, nursing homes and long-term skilled nursing facilities—often understaffed and lacking proper infection controls—are a breeding ground for harmful and often deadly bacteria. In a recent study of Southern California nursing home residents published by the Journal of Clinical Infectious Diseases and cited by the New York Times, 65% of nursing home residents harbored a drug-resistant germ, compared to 10-15% of hospital patients. These bacteria are particularly dangerous because they don’t respond to traditional antibiotics. The CDC reports that 90% of C. auris infections are resistant to at least one antibiotic, while 30% are resistant to two. In New York state, three cases have been resistant to all remedies.
What causes a drug-resistant bacterium? Heavy use of antibiotics can lead bacteria to become resistant. In turn, antibiotics become less effective. In speaking to the New York Times, Dr. Lynn Sosa, the deputy state epidemiologist of Connecticut, calls the bacteria “pretty much unbeatable and difficult to identify.” As part of its mission, the Committee to Reduce Infection Deaths has issued a brochure with guidelines to prevent infections in nursing homes. In addressing the C. auris crisis, New York health officials met in May to discuss potential new guidelines. The guidelines should be finalized by the end of the year.
In the meantime, nursing homes will have to contend with bacteria spores that get into everything—not just medical equipment or clothing, but also ceiling tiles or floorboards (which sometimes have to be ripped out). This menacing bacterium may be here to stay, so nursing homes and health officials will have to step up operations to protect elderly and vulnerable patients.