Drug-Resistant ‘Candida auris’ Spreading in Dhaka ICUs, Says icddr,b
Providing information on the spread of the drug-resistant fungus ‘Candida auris’ in various intensive care units (ICUs) in the capital Dhaka, the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) has stated that this “superbug” is no longer confined to neonatal ICUs; it is also infecting critically ill adult patients.
The international health research organization disclosed these findings on Tuesday, March 3, based on the results of a study conducted in the ICUs of one government and one private hospital in Dhaka.
According to a press release from the organization, the research has been published in the international journal Microbiology Spectrum.
The drug-resistant fungus ‘Candida auris,’ which is not easily treatable, is referred to by researchers as a “superbug.”
The report indicates that this so-called “superbug” was previously observed only in neonatal ICUs (NICUs). However, it is now causing infections among critically ill adult patients as well. This development has raised concerns about an increased risk of hospital-acquired infections. While earlier studies documented the spread of the fungus in NICUs, the new research shows that the problem is more widespread and that other ICUs are also being affected.
Medical experts note that ‘Candida auris’ can colonize the skin without causing symptoms. In some cases, however, it can enter the bloodstream and cause severe infections. The fungus poses greater harm to critically ill patients and those with weakened immune systems. Moreover, nearly all strains of C. auris are resistant to commonly used antifungal medications, making treatment particularly difficult. For these reasons, healthcare authorities worldwide consider Candida auris a serious public health threat.
Researchers at icddr,b stated that the study, published in Microbiology Spectrum, was conducted in the ICUs of one government and one private hospital in Dhaka. The government’s Institute of Epidemiology, Disease Control and Research (IEDCR) collaborated on the research, while technical assistance was provided by the Centers for Disease Control and Prevention (CDC) of the United States. A total of 372 ICU patients were included in the study between August 2021 and September 2022.
According to the report, patients were tested for the presence of ‘Candida auris’ on their skin and in their bloodstream immediately after ICU admission and subsequently during their stay. Skin and blood samples were analyzed in laboratories, and suspected samples were confirmed using the VITEK-2 method.
The study found that at some point during their ICU stay, approximately 7 percent of patients were found to carry C. auris. Notably, more than one-third of these patients acquired the fungus during their time in the ICU, indicating that the infection was primarily spreading within hospital settings.
The findings also revealed that the infection rate was higher in the government hospital compared to the private hospital. In the government hospital, nearly 13 percent of patients became infected with C. auris during their ICU stay, whereas the rate was approximately 4 percent in the private hospital. This difference highlights variations in infection prevention and control measures between the two hospitals. Compared with international research, the rate found in Dhaka’s ICUs is considerably higher. Studies conducted in high-income countries such as Canada and the United Arab Emirates have typically reported prevalence rates of less than 0.5 percent.
Patients found to carry C. auris were critically ill, had prolonged ICU stays, and required invasive medical procedures such as mechanical ventilation or the use of central and urinary catheters. Although these procedures are often life-saving, they can increase the risk of infection if proper hygiene and disinfection measures are not maintained.
Laboratory testing showed that all C. auris isolates were resistant to fluconazole, and all but one were resistant to voriconazole, meaning these drugs were ineffective in eliminating the pathogen. These medications are commonly used as first- and second-line antifungal treatments. Some isolates were also resistant to multiple drugs, further complicating treatment. This finding underscores the need for improved guidelines on antifungal use.
Dr. Fahmida Chowdhury, Head of the Antimicrobial Resistance (AMR) Research Unit of the Infectious Diseases Division at icddr,b and the lead researcher of the study, said, “This research clearly demonstrates that Candida auris is not limited to critically ill neonates; it poses a significant threat to all types of ICU settings. We have found clear evidence of in-hospital transmission and are observing high levels of resistance to commonly used antifungal medications. Therefore, strengthening infection prevention measures, enhancing surveillance, and exercising greater caution in treatment are now urgently required.”
Genetic analysis of selected samples revealed that the C. auris strains found in the ICUs largely belong to the South Asian clade. This suggests that the fungus has become established in the region and is not merely an isolated issue introduced from abroad.
The researchers have recommended regular and proper cleaning of hospital environments using effective chlorine-based disinfectants, ensuring strict hand hygiene practices among healthcare workers, and implementing routine screening in high-risk units to quickly identify infected or colonized patients. They have also emphasized the prudent and rational use of antifungal medications to preserve the limited effective treatment options. Additionally, the researchers noted that broader, large-scale studies across more hospitals in Dhaka and throughout the country are necessary to better understand the full extent of the problem.
DBTech/NA/EK/OR
