Silent Spread in the NICU: The Candida auris Concern
A potentially deadly fungal infection, Candida auris, is spreading in neonatal intensive care units (NICUs) in Bangladesh, according to a recent study. The fungus, known for its resistance to multiple antifungal medications, has been designated an “urgent antimicrobial resistance threat,” prompting researchers to call for heightened vigilance and strengthened surveillance across healthcare facilities.
The findings were published in the journal Microbiology Spectrum and highlighted by icddr,b on Sunday, 9 November.
Healthcare-associated infections (HAIs) have become a significant public health challenge worldwide. Among the microorganisms linked to such infections is Candida auris, part of the broader Candida family, which has emerged as a leading cause of fungal infections particularly in low- and middle-income countries in recent years.
The study, conducted jointly by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) and the Institute of Epidemiology, Disease Control and Research (IEDCR), was supported by the U.S. Centers for Disease Control and Prevention (CDC). The CDC had earlier declared Candida auris an “urgent antimicrobial resistance threat” in 2019 due to its resilience against multiple antifungal drugs.
Between August 2021 and September 2022, researchers examined 374 newborns admitted to NICUs in one public and one private hospital in Dhaka. The study found that 32 infants (9 percent) were colonized with Candida auris on their skin, and in one child, the infection entered the bloodstream. Among them, 14 neonates were already colonized at the time of admission, while 18 acquired the infection during hospitalization. A total of seven infants with colonization or bloodstream involvement later died.
Researchers say the pattern strongly suggests hospital-based transmission occurring within NICU environments.
Another recent icddr,b study similarly indicated that patients observed did not have Candida auris infections prior to their hospital admission.
Among the fungal samples collected, 82 percent were resistant to fluconazole, the primary first-line drug used to treat Candida auris. Reduced effectiveness of this medication could significantly limit treatment options.
Experts note that when a pathogen becomes resistant—similar to the rise of “superbugs” such as MRSA—the associated drugs become less effective over time. icddr,b infectious disease specialist Fahmida Chowdhury referred to Candida auris as a “superbug.”
The research also found that 81 percent of affected newborns were delivered by cesarean section. According to researchers, longer post-delivery hospital stays associated with cesarean births increase the likelihood of exposure to the fungus.
Icddr,b’s statement explained that Candida auris can persist on human skin without visible symptoms and survive for long periods. In roughly 10 percent of cases, the fungus progresses to invasive infection, particularly when it enters sterile areas of the body, such as the bloodstream, leading to severe outcomes.
Mortality rates linked to Candida auris infections in low-income and lower-middle-income countries are estimated at around 70 percent. Infants with underdeveloped immune systems, critically ill patients, and premature newborns are particularly vulnerable.
Fahmida Chowdhury, Associate Scientist and Head of AMR Research under the Infectious Diseases Division at icddr,b, said:
“This study provides critical evidence of superbug transmission among vulnerable newborns in the neonatal intensive care environment. It is a necessary first step toward administrative and policy-driven preventive action.”
The researchers recommend routine cleaning of hospital equipment and surfaces using chlorine-based disinfectants and improving hand hygiene among healthcare workers. They also emphasize the need for ongoing monitoring of Candida auris within NICUs to ensure rapid identification and isolation of infected infants for timely treatment.
DBTech/AP/IK/OR
