Hot Topics in IPC: Candida auris, Marburg Virus, and Pseudomonas From Eye Drops

Candida auris – Can’t We Get a Break?

We’ve all heard much about this for a while, so I won’t spend too much time on it. Still, the lack of attention that antimicrobial resistance (AMR) and health care-associated infections (HAIs) get is baffling. A fungal infection we frequently see in health care, Candida auris, is an opportunistic bug rapidly spreading across the United States. The CDC has increasingly shared concerns about this urgent public health threat that spread “at an alarming rate” during the pandemic. Some areas report significant upticks in cases, and 2021, there was a 200% increase in cases.

You can keep tabs on the spread of it here. We’ve seen reports about the rise in AMR since the COVID-19 pandemic. This new attention helps raise awareness; we mustn’t lose traction on prevention efforts like strict adherence to isolation precautions, cleaning/disinfection, screening, and hand hygiene. C auris is a tough bug, but it’s nothing we haven’t seen before, right?

Marburg in Equatorial Guinea

It’s never a good sign when you have silence during an outbreak. Several weeks have passed since the latest updates on this Marburg virus outbreak, but thankfully, we can now report some information (although it’s not good). Eight more cases have been identified and reported, with 7 dying from infection. Currently, there are a total of 9 confirmed and 20 probable cases. “Of the 8 new confirmed cases, 2 are from Kie-Ntem province, 4 are from Litoral, and 2 are from Centro Sur. The WHO said the provinces are about 150 kilometers (93 miles) apart, suggesting wider transmission. It also said uncertain epidemiologic links in Centro Sur suggest the potential undetected virus spread."

The group added that it had deployed experts to Equatorial Guinea to assist the nation's response and community engagement. The WHO said that the country is grappling with the virus for the first time, and its capacity needs to be strengthened. The concern is also that with such delays in case identification/communication, given the provincial borders with Cameroon and Gabon, these porous areas could serve as a source for transmission outside of Equatorial Guinea. Tanzania also reported its first Marburg outbreak, which brings the list of African countries which have reported Marburg events to 4 since 2021.

Pseudomonas with a Side of Eye Drops

This week’s hot topics are like a drug-resistant sandwich. The CDC has released a new update regarding their work with the Food and Drug Administration (FDA) and local public health departments to help collect data and halt the spread of an extensively drug-resistant strain of Pseudomonas aeruginosa (carbapenem-resistant, to be exact) that has not previously been seen in the United States. Sixty-eight cases across 16 states have been identified as of March 14, 2023, and per the CDC, “Most patients reported using artificial tears. Patients reported over 10 different brands of artificial tears, and some patients used multiple brands. EzriCare Artificial Tears, a preservative-free, over-the-counter product packaged in multidose bottles, was the brand most commonly reported. This was the only common artificial tears product identified across the 4 health care facility clusters.”

For reference in your facility, these are the CDC’s recommendations: “Patients should stop using EzriCare or Delsam Pharma’s Artificial Tears pending additional information and guidance from CDC and FDA. If patients were advised to use EzriCare or Delsam Pharma’s Artificial Tears by their health care provider, they should follow up with their health care provider for alternative treatment options."

The CDC’s update declared, “Patients who have used EzriCare or Delsam Pharma’s artificial tears and who have signs or symptoms of an eye infection should seek medical care immediately.” Currently, there is no recommendation for testing patients who have used these products and are not experiencing any infection signs or symptoms.