Candida Auris – An Emerging Superbug?
Midwife Louette Maccallum questions the impact of antibiotic treatments and asks – should Candida auris be considered a superbug?
Candida is a naturally occurring yeast in the body, living alongside all our other natural organisms. However, if our immune systems are compromised, the natural balance of these organisms is disrupted and the yeast grows out of control, causing havoc in our bodies.
Most women are susceptible to Candida albicans, a yeast infection in the vagina. It is very common during pregnancy, because the increase of octogen causes an increase in the production of glycogen, which causes normal yeast to grow more prolifically. This excess of yeast causes the typical symptoms of an itchy and burning sensation of the vagina, watery or creamy cottage-cheesy discharge, and swollen labia. It can also cause excessive bloating, gas and dyspareunia.
Recently, the Centre of Disease Control and Prevention in India reported cases of infection with a deadly fungus ‘Candida auris’, with outbreaks across four continents.
The rise of superbugs
Many women are prone to urinary tract infections, leading to repetitive courses of antibiotics, which destroys the natural bacteria in the gut and the vagina, causing an increase in yeast growth. Due to lack of healthcare education regarding probiotics, diet and cleanliness, many women have recurrent thrush infections, requiring repeat antifungal treatments.
Unfortunately, due to the frequency with which these antibiotic and antifungal treatments are prescribed, these self-same infection-causing bugs are building their own ‘weapons’ against the medicine designed to destroy them. They have become capable of preventing antibiotics and antifungals from entering their cellular structure.
The abilities of these bugs to protect themselves causes DNA changes, which they can transfer to other bugs of the same species, allowing rapid replication and ultimate resistance to antibiotic treatments. As the natural gut bacteria are destroyed through countless types of antibiotics, the immune system becomes weaker and the bugs get stronger. These then become known as SUPERBUGS.
Candida auris outbreaks
With these recent outbreaks, scientists have completed the genotype sequencing of Candida auris and have suggested that it has possibly previously been misidentified with other Candida species.
Since Candida auris is a deadly fungus which has been isolated in hospitals and in already-ill hospitalised patients, it is unlikely that the many pregnant women experiencing thrush have anything different from the normal candida albicans infection, which can be treated with standard medication.
However, with the indiscriminate use of antibiotics and antifungals, and with women self-treating with over-the-counter fungal treatments, are we possibly creating a scenario of misdiagnosis and therefore allowing the emergence of a superbug?
Candida auris raises concerns. It is resistant to three major classes of anti-fungal medication, which other species usually respond to. There have been 1500 cases in South Africa to date, with 80 new cases reported every month, mostly in Johannesburg and Pretoria hospitals and in private-sector facilities.
Managing Candida auris
- If repeat infections are resistant to Fluconazole, specific testing for Candida auris should be considered.
- Infected patients should be isolated. If the spread of infection is via fomites, or the hands of healthcare workers, then washing of hands and infection control must be of the utmost importance.
- Bare below the elbow: the transfer of bugs from patient to patient on the long sleeves of whitecoats and uniforms is not clinically proven but is a very probable factor in transmission of infections.
- The environment needs to be cleaned with a chlorine-releasing agent with a strength of 1000ppm and terminal cleaning with hydrogen peroxide; machinery and equipment must be thoroughly cleaned once a patient is transferred or discharged.
Centers for Disease Control and Prevention, ‘Candidiasis’, 6 October 2016, CDC. Accessed at: https://www.cdc.gov/fungal/diseases/candidiasis/
Centers for Disease Control and Prevention, ‘Candida auris: Questions and answers’, 16 March 2017, CDC. Accessed at: https://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-qanda.html
MediResource, ‘Superbugs: What are they and how are they formed?’. Accessed at: http://www.medbroadcast.com/channel/infection/overview/superbugs-what-are-they-and-how-are-they-formed
National Institute for Communicable Diseases, ‘Interim guidance for management of Candida auris infections in South African hospitals’, December 2016, Centre for Opportunistic, Tropical and Hospital Infections. Accessed at: http://www.nicd.ac.za/assets/files/2016-12-22%20InterimNICDRecommdtnsCAuris.pdf
Yeast Expert, ‘6 Most Common Types of Candida’, 12 October 2015, YeastInfection.org. Accessed at: http://www.yeastinfection.org/6-most-common-types-of-candida/
This article by Midwife Louette Maccallum originally appeared in Sensitive Midwifery Magazine in July 2017.