Dangerous, parasitic fungus Candida auris is becoming more common in hospitals; here are details about it

Candida auris can be deadly. (Photo by Kateryna Kon,
Science Photo Library via Getty Images)

When you think of fungi, you may think of spring mushroom hunting, but there are many "funguses" among us. Many are "parasitic in humans and are known to cause diseases. . . . Parasitic fungi most commonly enter the body through a wound in the epidermis (skin). Such wounds may be insect punctures or accidentally inflicted scratches, cuts, or bruises," says the Encyclopedia Britannica.

That is precisely how a new fungus is infecting humans. "In late March 2023, the Centers for Disease Control and Prevention highlighted the threat posed by a rapidly spreading fungus called Candida auris that is causing infections and deaths among hospital patients nationwide. The unexpected rise of this recently discovered pathogen is part of a larger trend of increasing fungal infections in the U.S.," reports The Conversation, a platform for journalism by academics.

Arif R. Sarwari is a physician and professor of infectious diseases at West Virginia University. Amid rising concerns among doctors and public health officials, Sarwari helped explain what Candida auris is, how it is spreading and how worried people in the U.S. should be." This information is particularly important for rural residents who tend to be older, sicker and have fewer medical resources for education and prevention. Here's the interview:

What is Candida auris? A recently identified, single-cell fungus that can infect humans and is moderately resistant to existing antifungal drugs. You might be familiar with superficial fungal infections – like athlete's foot or vaginal yeast infections – which are quite common and don't pose significant risks to most people. In contrast, Candida auris and other related fungi can cause infections within a person's body and are much more dangerous. . . . Recently, though, infections with species of candida that are much more resistant to drugs than Candida albicans – like Candida auris – have shot up, with a nearly fivefold increase since 2019."

How dangerous are candida infections? For the most part, healthy people do not have to worry about invasive candida infections. Two groups of people are most at risk for candida infections: first are patients in intensive care units who also have central intravenous catheters and receive broad-spectrum antibiotics. Patients with weak immune systems, such as cancer patients on chemotherapy, are also at high risk of candida infection. . . . The fungi can proliferate rapidly and overcome a person's immune system when a patient is sick and on antibiotics. . . . If candida cells on a person's skin contaminate an intravenous line, the fungus can get into a patient's bloodstream and cause often deadly bloodstream infections.

What treatments are available? Three classes of antifungal drugs can be used to fight invasive candida infections. Candida albicans are susceptible to all three and easier to treat than Candida auris, which is moderately resistant to all three classes of antifungals.

How common are invasive fungal infections? The CDC estimates that in the U.S., around 25,000 patients get candida bloodstream infections every year. . . . The recent emergence of drug-resistant and more transmissible Candida auris is raising alarms among health professionals. Because this species can contaminate surfaces and easily spread from patient to patient, the fungus is causing outbreaks both within and between hospitals.

Why are fungal infections increasing? The reasons for this increase are complicated, but I think there are two main drivers: more sicker patients in hospitals and a stressed health system. . . . I view the rise of drug-resistant fungi like Candida auris through the same lens as worsening antibiotic resistance. The more antibiotics people use, the greater the chances a resistant strain will become dominant.

What can the medical community do about it? There are a few options for fighting the rise of drug-resistant Candida auris. The most effective measures are good infection control practices. These protocols include practicing good hand hygiene taking measures to detect Candida auris infections early, and isolate patients to prevent the spread. Though relatively simple, these actions are key to preventing the spread of all antibiotic-resistant pathogens, not just fungi.

Pandemic roundup: why Covid can cause stillbirths; peer-to-peer mental health services for farmers; nearly 1 in 5 health-care workers have quit since the beginning of the pandemic

Here's a roundup of recent news stories about the pandemic and vaccination efforts:

It's already well established that stillbirths have increased in many areas with high Covid-19 rates. Now a new study suggests why: A coronavirus infection can invade and destroy the placenta, likely leading to stillbirths, the study says. Read more here.

Nearly a fifth of American health-care workers have quit since the beginning of the pandemic as they get increasingly burned out by the demands of overcrowded hospitals. A portrait of a Minnesota hospital shows what that stress looks like. Read more here.

Worker burnout is only one reason hospitals can't handle the new normal, says one analysis. Rural hospitals especially will continue to lose out: Urban hospitals with deeper pockets will keep poaching rural staff (example: traveling nurses), enabling lucrative elective surgeries. Smaller hospitals will continue to shoulder a disproportionate share of mild-to-moderate Covid-19 patients and will be more likely to have to pause elective surgeries and other non-Covid care. Read more here.

During the Delta variant surge last summer, rural counties with low vaccinations rates were hit the hardest, researchers found. Counties where the coronavirus vaccination rate was below 30% saw nearly double the case rate of counties where vaccination rates were over 50%. Read more here.

The pandemic has increased farmers' need for mental-health services, but many are reluctant to admit they need help. Programs that teach peer-to-peer counseling can be especially effective, but those and other programs may need more funding to remain sustainable. Read more here.

In January, more than 3,000 hospitalized patients became infected with the coronavirus during their stay, more than in any other month of the pandemic, new data show. Read more here.

The Food and Drug Administration delayed its review of Pfizer's coronavirus vaccine for children under 5 years old earlier this month. Sources familiar with the decision now say it's because a few children in the study got breakthrough infections of the Omicron variant after two doses of the vaccine. Since so few people get breakthrough infections, even a handful could be statistically significant. FDA officials and Pfizer agreed it would be better to wait for a larger sample size to assess the vaccine's effectiveness for that age group with both two doses and three doses. Results are expected in early April. Read more here.

Hospitals given semi-annual grades based on patient-safety metrics; post-op sepsis, other issues included for first time

Screenshot of Leapfrog page for Hazard Appalachian
Regional Healthcare Medical Center in Hazard, Ky.

A nonprofit group has released its semi-annual report grading hospitals for patient safety. The Leapfrog Group, based in Washington, D.C., rated 2,901 general acute-care hospitals, the most ever. The twice-yearly grades are based on more than 30 performance measures of patient safety that indicate how well hospitals protect patients from errors, injuries, accidents and infections. The safety guide is the only hospital ratings system based exclusively on a hospital's ability to prevent medical errors and harm to patients.

The group doesn't grade critical-access hospitals, since they don't have to report quality measures to the federal government. It also doesn't grade specialty hospitals, government hospitals, or hospitals that don't have enough publicly reported data.

For the first time, the report includes performance grades for post-operative sepsis, blood leakage and kidney injury. A news release notes that post-operative sepsis can result in "suffering, disability and sometimes death" for an estimated 160,000 Americans a year. It adds that sepsis in all settings kills over 270,000 people a year and is the costliest condition in U.S. hospitals. Further, it says that Black people are twice as likely as white people to be diagnosed with sepsis.

The report uses data from the Centers for Medicare and Medicaid Services, Leapfrog's own survey, and other supplemental data sources. Hospitals are only graded if they have submitted adequate data for evaluation, Leapfrog says. The site offers details on each measure under headings titled Infections, Problems with Surgery, Practices to Prevent Errors, Safety Problems, and Doctors, Nurses and Hospital Staff. It also includes an easy-to-read, color-coded scale that indicates how the hospital is performing.

Click here to see how your local hospital—and its neighbors—have scored.

Medicare penalizes 800 hospitals with highest rates of hospital-acquired infections, injuries; here's a link to a list

Medicare will pay 800 hospitals less this year because of high rates of patient infections and injuries. That's the highest number since the government established the Hospital Acquired Conditions Reduction Program five years ago under the 2010 Patient Protection and Affordable Care Act. In the past five years, 1,756 hospitals have been punished at least once, and 110 are being penalized for the fifth straight year, Jordan Rau reports for Kaiser Health News. Click here to see if your local hospital is on the list.

"Under the latest round of sanctions, each hospital will lose 1 percent of its Medicare payments for patients discharged between last October and this September. That comes on top of other penalties created by the health care law, such as annual payment reductions for hospitals with too many patients being readmitted," Rau reports. "Each year, the quarter of general hospitals with the highest rates are punished, even if their records have improved from the previous year." Critical-access hospitals and specialty hospitals like those for veterans, psychiatric patients, or children are excluded from consideration.

The hospital industry argues that the program creates an arbitrary cut-off for penalties. The American Hospital Association, a lobbying group, calculated that about 59 percent of the 768 hospitals punished in 2017 had HAC scores that were barely worse than hospitals not punished. "Hospitals also complain that the ones that do the best job testing for infections and other threats to patients appear to be among the worst based on statistics, while their more lackadaisical peers look better than they might be," Rau reports. However, the program's supporters argue that the threat of losing money motivates hospitals to improve.

Has the program helped decrease hospital-acquired conditions? Mostly: a June report by the federal Agency for Healthcare Research and Quality found an 8 percent decrease in such conditions from 2014 to 2016, but also found an increase in bedsores and urinary tract infections in catheterized patients during that time. The HACRP program bases its penalties on some of the conditions examined in the AHRQ report, Rau reports.

Penalties for patient-safety shortcomings hit 769 hospitals; could be nixed by Obamacare repeal

This is the third year federal government will apply penalties to hospitals that fall short of patient safety standards, leading one Consumers Union leader to wonder why hospitals aren't working harder to eliminate the infections and complications that are causing them to loose money, Trudy Liberman writes in her column for the Rural Health News Service.

“What I am most frustrated about is the lack of urgency in the country and at the agencies for eliminating these infections," Lisa McGiffert, head of the Consumers Union Safe Patient Project, told Liberman. "They are aware of them, but there’s not a sense of urgency to stop them."

"The penalties, along with the entire program to eliminate hospital-acquired conditions, were authorized under the Affordable Care Act," Liberman writes. "They could be in jeopardy if the law is repealed. Some hospitals probably would be happy if they disappeared."

Penalties are levied against hospitals that have a high number of patients with avoidable infections and complications, including blood clots, urinary-tract and surgical-site infections, bed sores and falls. And this year, infections related to antibiotic-resistant infections, like methicillin-resistant Staphylococcus aureus (MRSA) and C. difficile, have been added to the list.

Medicare will impose a 1 percent cut in payment to 769 U.S. hospitals who fell short of these patient safety standards in the fiscal year that ended Sept. 30. Since the inception of the penalty program, Lieberman reports, 241 hospitals have been punished in all three years, but 347 that were penalized last year are not on the "bad-guy list."

Critical-access hospitals (by definition, rural) and specialized hospitals that treat psychiatric patients, veterans and children are exempt from the penalties.

Leapfrog Group issues its latest twice-yearly rankings of 2,633 hospitals for patient safety

The Leapfrog Group today announced its latest Hospital Safety Grade, which twice a year assigns letter grades to 2,633 U.S. hospitals for patient safety. In this round, 844 hospitals earned an A, and 658 got a B. The most common grade was a C, given to 954 hospitals. There were 157 Ds and 20 Fs. Results are searchable by hospital, ZIP code, city and state. To look up hospitals click here. Many rural hospitals are not rated because they are classified as "critical access" and thus don't have to report their quality measures. But you could ask them for those reports.

Grades are calculated using 30 publicly available hospital safety performance measures from the Centers for Medicare & Medicaid Services, the Leapfrog Hospital Survey, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention and the American Hospital Association’s Annual Survey and Health Information Technology Supplement.  (Map shows percentage of hospitals in each state that received an A)

Early research promising for an ancient remedy to fight MRSA, an antibiotic resistant superbug

Researchers in the United Kingdom reported that an ancient cure might help kill the superbug MRSA, Justin Wm. Moyer reports for The Washington Post. The leading cause of superbugs, organisms that are resistant to some—if not all—antibiotics, like methicillin-resistant Staphylococcus aureus, or MRSA, is the overuse of antibiotics. Scientists have been charged to fight these infections through "technological" means.

 But researchers have recently found that MRSA is "vulnerable to an ancient remedy" made of garlic, some onion or leek, copper, wine and oxgall—or cow’s bile. Garlic and copper continue to be thought of as having antibiotic or antimicrobial properties. “We were absolutely blown away by just how effective the combination of ingredients was,” Freya Harrison, one of the researchers from the University of Nottingham, told the BBC, Moyer reports.

The remedy, noted as eye salve, was found in a manuscript written in Old English from the 10th century called "Bald's Leechbook," a well-respected physician's desk reference from that time, Moyer reports. He also notes that not every remedy in the manuscript is credible, like this one from the translation of an Eastern Algo-Saxonist: “In case a man be a lunatic; take skin of a mereswine or porpoise, work it into a whip, swinge the man therewith, soon he will be well. Amen.”

The Centers for Disease Control and Prevention estimated MRSA contributed to the deaths of more than 5,000 people in the United States in 2013, Moyer reports, writing that "some say it could eventually kill more people than cancer."

The  research will be presented at the upcoming Annual Conference of the Society for General Microbiology in Birmingham. Moyer notes that the abstract for the conference cautions that "oxgall was no cure-all." Christina Lee, an associate professor in Viking studies at the University of Nottingham, told Moyer "that it was the combination of ingredients that proved effective against MRSA—which shows that people living in medieval times were not as barbaric as popularly thought."

Consumer Reports ranks hospitals for safety

How safe is your hospital? Consumer Reports released its hospital ratings, ranking Miles Memorial Hospital in the small town of Damariscotta, Maine, as the country's safest and Bolivar Medical Center in Cleveland, Miss,. as the least safe hospital in the U.S. The ratings come on the heels of a study published last year in the Journal of Patient Safety that found that 440,000 deaths occur each year in U.S. hospitals because of a medical error.

Ratings were determined based on "patient outcomes (avoiding infections, readmissions, avoiding mortality, and adverse even ts in surgical patients), patient experience (including communication about hospital discharge, communication about drug information and other measures), and hospital practices (appropriate use of scanning, and use of electronic health records)," Consumer Reports says. Those measures were then combined for a safety score from 1 to 100. Miles Memorial received a 78, while Bolivar Medical Center got an 11. Rankings by state, city and county are available by clicking here (subscription may be required).

Bolivar isn't alone in its poor ranking. The average overall score of the more than 4,000 hospitals ranked was 51, and 43 hospitals scored below 30. John Santa, M.D., medical director of Consumer Reports Health, said, “It is unacceptable that so many hospitals are doing so poorly, especially since our ratings show that some hospitals can do a good job at keeping patients safe.” (Read more)

To read how Consumer Reports rated hospitals click here. To read the Consumer Reports Health report on the rankings click here.

UPDATE, April 4: There are many forms of hospital rankings, some done with questionable business practices such as "licensing fees" they get from hospitals, notes Pia Christensen of the Association of Health Care Journalists.

Data on hospital-acquired conditions is online

The federal Centers for Medicare and Medicaid Services (CMS) has posted information about hospital-acquired conditions on its website, and The Courier-Journal of Louisville not only has a story about it today, it has an easily serarchable database of Kentucky hospitals.

This is not information that the American Hospital Association wants online, at least in its current form. “You have to look at the totality of the care. And these little snapshots that CMS wants to pick out are very misleading,” Kentucky Hospital Association Senior Vice President Nancy Galvagni told C-J reporter Patrick Howington. She said the data don't allow for differences between hospitals, such as specialities, that may cause higher rates of acquired conditions.

However, Doug Leonard, president of the Indiana Hospital Association, told Howington that the industry needs to “embrace transparency. Sometimes we don't like the results of that, but I think transparency is good for us and good for the public.” Dr. Kevin Kavanagh of Somerset, Ky., chairman of the nonprofit group Health Watch USA, "said the data's greatest value may be to help hospitals spot areas that need improvement, rather than to help patients choose between hospitals," Howington writes. "In fact, a hospital shown as having a high complication rate 'may be the safest hospital to go to, because they were under pressure to get the problem corrected.'" (Read more)

The conditions tracked are trauma, such as falls; blood and urinary infections from catheters; bedsores; poor blood-sugar control for diabetics; foreign objects left in bodies; air or gas bubbles in blood vessels; and transfusions of the wrong blood type.

Hospital mistakes not declining, study finds

Hospitals have not become safer for patients, the first major study in a decade suggests. A Harvard Medical School study of 10 unnamed rural and urban North Carolina hospitals from 2002 to 2007 found that, in spite of preventive efforts, the number of incidents that harmed patients did not decline over the time studied. The study looked at the Tar Heel State because its hospitals have been more involved than most in prevention.

Complications from procedures or drugs and hospital-acquired infections were the most common adverse events. The study, which is being published today by The New England Journal of Medicine, found that about 18 percent of patients were harmed by errors that were preventable 63 percent of the time. While most were treatable injuries, an estimated 2.4 percent contributed to or caused death."

Lead author Dr. Christopher P. Landrigan, a Harvard professor, said it is unlikely that hospitals in other regions are performing any better. He said the present limited voluntary reporting system is insufficient and a federal-level, mandatory reporting system that requires all hospitals to report errors is needed.

Dr. Robert Watcher, chief of hospital medicine at the University of California, San Francisco, told Denise Grady ofThe New York Times that the findings are a warning for the patient-safety movement that little progress is being made far too slowly. "Process changes, like a new computer system or the use of a checklist, may help a bit,” he said, “but if they are not embedded in a system in which the providers are engaged in safety efforts, educated about how to identify safety hazards and fix them, and have a culture of strong communication and teamwork, progress may be painfully slow.” (Read more)

A recent report from the inspector general of the Department of Health and Human Services reached similar conclusions. The study of a sample of Medicare patient discharge records found that 13.5 percent or 134,000 patients had experienced injury during hospital stays in October 2008. Such injuries could cost Medicare billions of dollars a year for added treatment. In the case of 15,000 patients in the month studied, medical errors contributed to patient deaths.