Medical directors and directors of nursing in long-term care (LTC) have long known about the threat of drug-resistant bacteria in their facilities. In fact, reducing these infections and outbreaks is a hallmark of a sound infection prevention and control program. I recently wrote about antibiotic-resistant infections, and I speak on the topic often.

 

There’s another threat of which we must be aware: drug-resistant fungal infections. More than 300 million people are infected with fungal diseases each year across the globe, according to estimates from the Global Action Fund for Fungal Infections. Of those infected, 25 million are at risk of dying or losing their eyesight.

 

The devastating COVID-19 outbreak in India has highlighted a type of fungus that can increase morbidity and mortality in patients - mucormycosis, or “black mold.” Mucormycosis is ubiquitous in nature and for most healthy people presents little risk for causing significant disease. It generally infects patients who are immunosuppressed caused by certain medications, immune system deficiencies, and most commonly those with uncontrolled diabetes mellitus.

 

The infection generally starts in the sinuses and can spread locally to the brain or systemically through the blood. It has a very high morbidity and mortality, but it is treatable. LTC residents’ inherent conditions make them particularly susceptible to this fungus, making it a significant threat in LTC.

 

As with mucormycosis, there are other fungal infections that should be on our radar in LTC. Most infections are associated with some type of immune suppression. There are many possible pathogens but the Candida class is one of the most common threats and can cause significant morbidity and even mortality. Infections from Candida can be as simple as a urinary tract infection or more invasive infections, such as sepsis, pneumonia and meningitis. Previously, most of these pathogens were treatable with antifungals, and many still are, but there is an increasing prevalence of drug resistance in fungus very similar to what we see with bacteria.

 

The most recent Candida species to be added to the Centers for Disease Control and Prevention’s (CDC) list of worrisome resistant pathogens is Candida auris. The CDC now considers this particular species a serious global health threat. There are a number of characteristics that support this designation including drug resistance to multiple antifungals (with some strains being resistant to all known antifungals) as well as difficulty being identified by standard laboratory methods and known to cause outbreaks in healthcare settings.

 

We in LTC tend to concentrate on bacterial infections as they are more common but we cannot forget that fungal infections are common and should be targeted as well in any antimicrobial stewardship program in LTC.

 

AMS Infection Prevention Partners is here to help. To learn how to control drug-resistant fungal and bacterial infections - or to get started with an antibiotic stewardship program - in your long-term care facility today, drop us a line.

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