What Older Adults Need to Know About a Potentially Deadly Fungal Infection

Why does it spread so easily?

C. auris can remain on a patient’s skin for months or longer and contaminate nearby surfaces and medical equipment, Permpalung says.

Ostrosky says the fungus can linger on items such as blood pressure cuffs and thermometers.

“It’s very hardy in the environment, very sticky,” Ostrosky says. “It survives temperatures that other yeast are not commonly surviving.”

A person who carries the fungus without symptoms can leave it behind on bed rails, bedside tables, buttons, knobs and switches, Rupp says. Health care workers can then carry it to another patient if they do not clean their hands properly.

Patients may also move among hospitals, nursing homes, dialysis centers and rehabilitation facilities, carrying the fungus with them without realizing it.

Some everyday cleaners will not kill C. auris. Bleach and hydrogen peroxide are among the ingredients found in products the Environmental Protection Agency has approved for use against the fungus. Other products on the agency’s list use ingredients such as hypochlorous acid or peracetic acid.

“Spread is not inevitable,” Permpalung says. “Early detection, effective environmental disinfection, consistent hand hygiene, appropriate barrier precautions and communication during transfers can prevent or limit outbreaks.”

Who is most likely to become seriously ill?

The greatest risk is among patients who are already seriously ill, especially those with invasive medical devices or prolonged stays in hospitals or long-term care facilities.

“Risk factors for acquisition include being seriously ill and in a hospital,” Rupp says.

Many people who carry C. auris never develop a serious infection. But patients who are frail, have a weakened immune system or rely on devices such as catheters, breathing tubes or feeding tubes are more likely to develop invasive disease, Rupp says.

Permpalung says other risk factors include:

• A long or repeated stay in a hospital or long-term care facility
• A ventilator, catheter, feeding tube, central line or tracheostomy
• Open wounds or recent surgery
• A weakened immune system
• Prolonged use of broad-spectrum antibiotics or antifungal drugs
• Repeated transfers between health care facilities

People living independently in the community who do not have these risk factors remain unlikely to encounter the fungus.

“C. auris is primarily a health care-associated organism,” Permpalung says. “It is not behaving like influenza or COVID-19, and it is not known to be spreading widely through ordinary community contact.”

Can it be treated?

Most C. auris infections can still be treated.

For most adults with an infection, doctors start with an intravenous antifungal drug called an echinocandin, according to the CDC.  

“Although C. auris is often resistant to some first-line antifungal medications that are often used to treat other species of Candida, a number of other classes of antifungals usually remain active and treatment is often effective,” Rupp says.

Some strains, however, resist echinocandins and other antifungal drugs, which can sharply limit treatment options.

“The big concern for us is that this is one of those bugs that’s a perfect threat because not only is it resistant to the normal antifungals that we use for fungal infections, but it can be resistant to the second and third sort of class antifungals,” Ostrosky says. “And we occasionally have one that’s basically untreatable with the current antifungals.”

Outcomes can be poor, but many patients with C. auris are already seriously ill. That makes it difficult to determine how much the fungus contributed to a patient’s death.

Is it safe to visit someone in a hospital or nursing home?

For most healthy visitors, the risk is low.

“If a visitor to a hospital or nursing home is healthy and performs good hand hygiene, the risk of acquiring C. auris is low,” Rupp says.

Visitors should wash their hands when entering and leaving a patient’s room and follow any instructions about gowns or gloves.

“If you’re washing your hands when you’re visiting, you’re doing 90 percent of the work,” Ostrosky says.

People should not skip needed medical care or stop visiting loved ones because of a general fear of C. auris.

“For an older adult living in the community who does not have frequent health care exposure, invasive medical devices or complex medical needs, the risk appears to be low,” Permpalung says.

What can older adults do to lower their risk?

Most of the work of preventing C. auris falls to hospitals and long-term care facilities. But patients and families can still speak up.

Consider asking whether catheters, breathing tubes and other invasive devices are still needed. The longer those devices stay in place, the more opportunities germs have to enter the body.

Rupp advises looking for facilities with a strong patient-safety record, including clear hand-hygiene practices and low rates of infections tied to medical devices or surgery.

Older adults can also lower their chances of needing hospital care by staying current on vaccinations, avoiding smoking and taking other steps to protect their health, Rupp says. Antibiotics and antifungal medicines should be used carefully because overuse can help resistant germs survive and spread.

“Unfortunately, these antimicrobial-resistant pathogens prey upon the most vulnerable,” Rupp says.

What should families ask a nursing home or hospital?

Families can learn a lot by watching how a facility handles the basics.

“I always say that if you walk in a facility and it’s clean and it smells good and you see people washing their hands, you’re good,” Ostrosky says. “This is a facility that takes care of infection problems.”

Families can ask whether the facility has cared for patients with C. auris, what precautions it takes after a positive test and how it cleans rooms and shared equipment.

Families can also ask whether the facility screens patients arriving from hospitals, nursing homes or other higher-risk settings. Rupp says some facilities swab areas such as the armpits and groin to find patients who carry the fungus without symptoms.