Super fungus Candida auris: What you need to know about catching bugs in hospitals

A New York Times report said that the deadly drug-resistant fungus Candida auris spreads easily in hospitals, with outbreaks caused by contact with infected patients and contaminated surfaces or equipment.
A New York Times report said that the deadly drug-resistant fungus Candida auris spreads easily in hospitals, with outbreaks caused by contact with infected patients and contaminated surfaces or equipment.PHOTO: ST FILE

SINGAPORE - The deadly drug-resistant fungus Candida auris, which kills about half of its victims within 90 days, has sparked alarm after news of it spreading globally went viral.

It has emerged in locations like China, Europe, the United States, South America, India, Australia, South Korea and Japan.

The Straits Times reported on Tuesday that 11 here have been infected since 2012. Three of those infected, including one of two deaths, were treated at Singapore General Hospital between 2012 and 2017.

A New York Times report said that the fungus spreads easily in hospitals, with outbreaks caused by contact with infected patients and contaminated surfaces or equipment.

Medical institutions have been reluctant to disclose outbreaks for fear of being seen as "infection hubs".

While Dr Ling Moi Lin, director of infection prevention and epidemiology at SGH, said there has been "no outbreak or spread" of C. auris in the community here, the fungus has brought up more general fears about the risk of infection at hospitals.

Here's what you need to know about the risk of catching an infection from hospitals, in particular super bugs.

 
 
 

HEALTHCARE-ASSOCIATED INFECTIONS

Generally, if you are warded in a hospital here, you already have a one in nine chance of catching a bug during your stay.

Last October, ST reported that a comprehensive study of 5,415 adult patients in 13 acute hospitals here found that 11.9 per cent caught an infection while being treated for other conditions.

 

Patients in every single bed in eight public and five private hospitals were involved, including those in intensive care. Together they accounted for more than 86 per cent of acute care beds in the country in 2014

But the risk of healthcare-associated infection (HAI) is not equally spread.

Those staying in public hospitals have a higher risk of catching a superbug.

In the study commissioned by the Ministry of Health, slightly above 12 per cent of patients staying in public hospitals compared to less than 9 per cent of private hospital patients were affected.

The paper also noted that the 11.9 per cent HAI rate here is higher than the 6 per cent in Europe and about 9 per cent in other South-east Asian countries. But the higher rate here might be due to a different mix of patients.

WHO IS AT HIGHER RISK?

Men, older people and surgery patients are among those most at risk.

Older men in hospital for surgery were identified as the group at highest risk of getting an infection during their stay.

Singapore has an ageing population and older people tend to have multiple illnesses that reduce their resistance to bugs.

In general, surgery patients have 1.8 times the risk of other patients, and men had a 1.5 times higher risk of infection than women.

Some bugs causing infections could have been brought in by the patient, laying dormant until the person's immune system was breached.

A common reason for a breach is the use of catheters, Associate Professor Hsu Li Yang, who heads the Infectious Diseases Programme at the NUS Saw Swee Hock School of Public Health, told ST last October.

The study found that half of urinary tract infections, a quarter of hospital-acquired pneumonia and a fifth of bloodstream infections were linked to the use of such devices.

This is because such devices allow the bug to bypass the body's usual protections, Prof Hsu said. The MOH study noted that infections contracted these way were "highly preventable".

'SUPER BUGS'

C. auris contributes to a much larger and growing global problem of antimicrobial resistance.

Antimicrobial is an umbrella term for antibiotic, antifungal and antiviral medication.

Scientists say unless more effective new medicines are developed and unnecessary use of antimicrobial drugs is sharply curbed, risk will spread to healthier population, The New York Times reported.

ST reported last March that according to the UK Review on Antimicrobial Resistance, superbugs kill around 700,000 people worldwide each year.

By 2050, 10 million people could die each year if existing antibiotics continue to lose their effectiveness, eclipsing the eight million expected to die that year from cancer.

The problem is so serious that the United Nations General Assembly was convened in 2016 to manage the crisis of increasing resistance to antimicrobial drugs.

Singapore is a small country, so attempts to cut down on antimicrobial resistance (AMR) here are unlikely to impact the global scene.

A lot of antimicrobials, antibiotics in particular, are used in farming, a sector that is pretty small here.

But antimicrobial resistance here is still an issue. More than half the patients in hospital here are on at least one antimicrobial, and not all patients on antimicrobials had infections; some received the drug as a precaution against infection.

Singapore has formed an inter-ministerial committee to provide a whole-of-government effort to fight antimicrobial resistance, it was reported in 2017.

WHAT SORTS OF BUGS?

The study commissioned by the Health Ministry found that while most of the infections were mild to moderate, there were some that could be severe, possibly even fatal, and came on top of whatever medical problems patients were already being treated for.

About one in four of those affected had an infection in their bloodstream, while a similar number had pneumonia.

Apart from general bugs, the most common "super bug" caught here was methicillin-resistant Staphylococcus aureus.

MRSA - yes, it is so common that it has its own abbreviation - can stay on food without being destroyed by heat.

In very serious cases, it could cause infections that lead to death.

But the incidence rate for MRSA has fallen from 0.84 per 10,000 patient days in 2013 to 0.38 in 2017, MOH said in 2017.

Other hard-to-treat, multidrug-resistant bacteria include Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa.

These superbugs can cause infections that lead to septic shock and multiple organ failure.

HOW TO PREVENT INFECTIONS

Super bugs are most lethal to people with immature or compromised immune systems, including newborns and the elderly, smokers, diabetics and people with autoimmune disorders who take steroids that suppress the body's defences.

It might not be possible to stop a superbug from infecting people. But good hygiene practices can help to slow the spread.

These include washing one's hands or covering the mouth when coughing and sneezing.

Vaccines significantly reduce the incidence of infections, which in turn reduces the need to use antimicrobials to treat the ailment.

Farms can reduce the use of antibiotics in animals.

Giving animals antibiotics to hasten their growth has led to an increase in resistance, and these resistant bugs can be passed from animals to people.

People can also get infected by these bugs from the air, soil and water they come into contact with.

It is important to make sure that waste water from places that make use of or produce antimicrobials do not carry trace amounts of the drugs.

The drugs could build up resistance in waterborne bugs and even fish - which could affect people who eat them.