STATEN ISLAND, N.Y. -- On the same day the Centers for Disease Control (CDC) and Prevention released a harrowing study that showed more people in the United States are dying from antibiotic-resistant infections than previously estimated, New York became the first state to release a list of medical facilities that have treated patients with candida auris, a fungus resistant to major medicines.
Staten Island’s three hospitals appeared on the list, published in the New York Times, along with five long-term health care facilities and hospices. In total, the list includes 64 hospitals and 103 nursing homes, mostly centralized in Brooklyn, Queens and Manhattan.
C. auris, according to the New York State Department of Health (NYSDOH), is an emerging multidrug-resistant yeast. It has been reported in several countries and is known to cause severe illness in hospitalized patients.
The fungus does not respond to commonly used antifungal drugs, according to the NYSDOH, making it difficult to treat. Additionally, C. auris can be transferred on surfaces in healthcare environments and can be spread on the skin of patients. The CDC has released specified measures for health care facilities to take in order to limit the spread of the fungus.
While the 2019 CDC report concerned multiple antibiotic-resistant infections that have caused profound concern, C. auris has become especially prevalent in New York, where 388 cases have been confirmed as of Oct. 29, 2019.
The fungus, which often occurs in patients when they are already experiencing ailments, can get into an individual’s bloodstream, causing severe sickness. When in the bloodstream, the fungus can begin multiplying and causing infections in organs, doctors say.
Staten Island’s three hospitals were listed as facilities that have treated patients with C. auris, the New York state list indicated.
Dr. Mark Jarret, the chief quality officer for Northwelll Health, which manages Staten Island Unviersity Hospital’s north and south campuses, said on Thursday that both hospitals are abiding by CDC guidelines that concern properly cleaning patient rooms and other practices, aiming to limit the spreading of the fungus.
However, Jarret said that "isn’t always 100% successful,” due to the nature of the fungus, which can be easily spread on surfaces. Jarret did not disclose the amount of cases the hospitals have experienced.
While the hospitals already undertook steps to regularly clean and disinfect rooms, Jarret said, “Because it’s a fungus, the cleaning of the rooms and decontamination has to be a little different and a little more prolonged.”
While isolating any infections is vital to patients that are often in a vulnerable state, Jarret said the “overuse of broad-spectrum antibiotics” is also a primary concern of healthcare facilities.
“These organisms, through evolutionary means, have learned to develop resistance to survive,” Jarret said.
“It’s about using the right antibiotic at the right time," he said, adding that Staten Island hospitals, alongside many others in New York, engage in “antibiotic stewardship," which refers to a set of coordinated strategies to improve the use of anti-microbial medication.
Richmond University Medical Center in West Brighton, named on the New York state list, encountered its first case of C. auris in 2017, but it did not originate at the hospital, said hospital spokesman Alex Lutz.
Since the outbreak of C. auris, the hospital has “put a lot of aggressive procedures in place in accordance with the New York City Department of Health, New York State Department of Health and our own infection department here,” Lutz said.
The procedures include strict bleach cleaning along with UV light disinfection, which Lutz said has been “a major factor” in the hospital’s effort to reduce the spread of the fungus. RUMC has also been closely working with its microbiology laboratory to ensure proper practice in limiting the escalation of C. auris.
“Due to those measures, we have been able to limit that exposure at the hospital, which has been relatively low,” Lutz said.
Over the last three years, RUMC has treated 16 patients who tested positive for C. auris; however, Lutz said all of those cases originated elsewhere.
Five long-term care facilities and hospices on Staten Island were listed as medical facilities that have cared for patients with C. auris.
The Richmond Center for Rehabilitation and Specialty Healthcare in Stapleton, named on the aforementioned list, has received two cases of patients with C. auris since 2018, a spokesman said.
"Richmond Center has been working very closely and diligently with the Department of Health and local hospitals regarding the outbreak of the drug-restraint germ fungus candida auris,'' said Jeff Jacomowitz, a spokesman for the center. "Over the past year since 2018, Richmond Center received two cases from local area hospitals who have been receiving treatment for this germ. With both cases, the hospital was in direct contact with Richmond Center and the Department of Health in order to stop any spreading of this infection at Richmond Center. There are no other cases at Richmond Center.”
Clove Lakes Health Care and Rehabilitation Center spokeswoman Jane Harris said the center takes extreme precautions in testing patients before their admittance, due to the vulnerable nature of its population.
Harris said the center cared for one patient that did not initially test positive for the drug-resistant fungus upon entry, but was later diagnosed after the patient was tested at another hospital.
The patient “did not return,” Harris said.
The New Vanderbilt Rehabilitation and Care Center, the Silver Lake Specialized Rehabilitation and Care Center and the Staten Island Care Center — all of which were named on the list of hospices who treated patients with C. auris — did not respond to a phone call seeking comment or further information regarding the amount of patients the locations treated.
The CDC said in its report that, on average, someone in the United States gets an antibiotic-resistant infection every 11 seconds and that someone dies every 15 minutes.
When including bacteria like clostridioides difficilie, which can cause deadly diarrhea, the country’s number of infections of antibiotic-resistant bacteria and fungi exceeds three million, the CDC said.
More than 48,000 deaths have also been recorded, according to the CDC.
Meticulous attention is needed to limit the advancement of fungi like C. auris, the NYSDOH says, including healthcare professionals utilizing proper hand hygiene, using gowns and gloves, and appropriate and effective environmental cleaning and disinfection by the healthcare facility.