Hospital Authority strengthens control measures against superbug Candida auris after Hong Kong outbreak

Michelle Wong

The Hospital Authority has stepped up control measures in the fight against deadly superbug Candida auris after a month-long outbreak in Hong Kong hospitals.

The multidrug-resistant fungal species has been increasingly prevalent around the world since 2009, with 16 cases recorded in the city in a breakout earlier this summer.

The pathogen, which could cause bloodstream infections and even death, has spread to more than 20 countries in Asia, Europe, America, Africa and Australia, with those hospitals affected reporting average fatality rates of 30 per cent.

Dr Raymond Lai Wai-man, chief infection control officer at the Hospital Authority, announces new measures to boost the city’s fight against Candida auris. Photo: Michelle Wong

Hospital Authority chief infection control officer Dr Raymond Lai Wai-man said they were preparing for a return of the superbug.

“We do not rule out the possibility of the pathogen spreading to Hong Kong, as Hong Kong is an international city for travellers and the number of global cases has been on the rise,” he said.

“But we will closely monitor the situation so there will be a smaller chance of a large-scale outbreak.”

Sixteen male carriers of Candida auris aged between 36 and 92 have been identified in Hong Kong, without signs of infection, between June and July this year.

The patients were treated at Princess Margaret Hospital in West Kowloon and North Lantau Hospital and now tested negative for the fungal species.

The first two cases involved a 48-year-old man who travelled to Switzerland and a 59-year-old American resident who had a cardiac arrest during his transit at Hong Kong International Airport.

Both had stayed in the intensive care unit of Princess Margaret Hospital.

There was an outbreak of the Candida auris pathogen in Hong Kong hospitals in June and July of this year, prompting the Hospital Authority to announce reforms. Photo: Handout

“We can’t say for sure the pathogen was spread to Hong Kong by the first two carriers from overseas as we did not do a screening when they were first admitted to the hospital. We only suspected that because there were quite some cases in the US,” Lai said.

There had been 587 cases reported in the US, according to Centers for Disease Control and Prevention.

Candida is a fungus commonly found in natural environments and in parts of the human body such as the oral cavity, the digestive tract, the skin and vagina. Its prevalence has been caused by excessive or abusive use of antibiotics.

While carriers generally do not show infection symptoms, the fungus might occasionally infect patients with impaired immunity.

First case of multidrug-resistant fungal infection recorded in Hong Kong

In response to the recent outbreak, the Hospital Authority has strengthened its control measures, including screening all patients who had been admitted to hospital overseas in the past year and were going to stay in high-risk wards such as intensive care units and clinical ontology.

There have also been laboratory upgrades to improve the identification and speciation of the pathogen.

Infected patients would be isolated while other patients who stayed in the same cubicle or room in the past month would also be traced and tested for the fungus.

Effective disinfectant and special cleaning devices would be used to enhance environmental hygiene.

“As we step up the control measures, we can identify the pathogens promptly and initiate the appropriate control measures at a relatively faster speed,” Lai said.

Such measures were already in force at hospitals in West Kowloon and Eastern New Territories while other hospitals will follow soon, he added.

Candida auris is a more drug-resistant species of Candida, with 90 per cent of the infections being resistant to at least one of the major antifungal drugs and 30 per cent resistant to two or more major drugs.

Killer infection at Hong Kong's doorstep as city fights superbug war

Its arrival piled pressure on the city already grappling with superbug infections that resulted in about 700 deaths each year in public hospitals. 

Candida auris mainly spread through contaminated medical devices, the environment and via medical staff.

Outbreaks of the fungal species usually happen in hospitals, where patients with diabetes and those undergoing surgery or being treated with invasive medical devices faced a higher risk of infection.

Also at increased risk were patients taking broad-spectrum antibiotics and antifungal drugs.

The species could stay inside the body of a carrier for months without any sign of symptoms. But once infected, patients might experience serious illness such as candidemia, pericarditis and pneumonia, depending on the organs affected.

Despite the risks, Lai said the general public need not to worry too much about the pathogen.

“This is a hospital bug, not a community disease. Healthy individuals or patients with a normal immunity will not be infected easily,” he said.

The pathogen was also resistant to some common disinfectants, making it able to survive in the external environment for a long period of time.

Mount Sinai Hospital in New York was reportedly ripping out its ceilings and floor tiles to eradicate the invasive fungus after a patient was infected and died in the room last year.

This article Hospital Authority strengthens control measures against superbug Candida auris after Hong Kong outbreak first appeared on South China Morning Post

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