‘Drug resistant fungal ‘superbug’ spreads in Dhaka ICU’s’

A dangerous drug resistant fungus identified as ‘Candida auris’ has been found spreading throughout intensive care units in hospitals across Dhaka posing a significant threat to critically ill patients beyond newborn care facilities.

The alarming discovery was made through research conducted by icddr,b revealing that this fungal superbug has established itself more broadly than previously understood.

Published in Microbiology Spectrum, the comprehensive study examined patients in both public and private tertiary hospitals in Dhaka. The research team worked alongside the Institute of Epidemiology Disease Control and Research with technical assistance from the United States Centers for Disease Control and Prevention.

Between August 2021 and September 2022 the investigation followed 372 ICU patients tracking the presence and spread of the resistant organism.

The research methodology involved testing patients immediately following admission and conducting follow up assessments during their ICU treatment period. Scientists collected skin swabs and blood samples which underwent laboratory analysis with suspected cases verified through VITEK-2 testing protocols.

While Candida auris can exist harmlessly on human skin without producing symptoms it has the potential to invade the bloodstream and trigger severe potentially fatal infections. The fungus presents particular danger to critically ill individuals and those with compromised immune systems.

What makes this pathogen especially troubling is its resistance to widely available antifungal medications with nearly all identified strains showing immunity to standard treatments. Global health organizations have classified C auris as a major healthcare associated risk.

Study findings revealed approximately seven percent of examined patients carried C auris at some stage during their intensive care treatment. Significantly over one third of those colonized acquired the fungus after admission demonstrating that transmission occurs predominantly within hospital environments. The public facility showed notably higher transmission rates with roughly thirteen percent of patients becoming colonized during their stay compared to four percent at the private institution suggesting variations in infection control protocols between the two settings.

These figures substantially exceed rates documented in developed nations where Canadian and United Arab Emirates studies have recorded colonization levels well under half a percent.

Patients colonized with C auris typically exhibited severe illness required extended ICU stays and underwent invasive medical interventions including mechanical ventilation and catheter placement. While such procedures often prove life saving they simultaneously elevate infection risk when rigorous hygiene and sanitation protocols are not maintained.

Laboratory analysis demonstrated complete resistance to fluconazole across all samples with only one exception showing sensitivity to voriconazole which serve as primary and secondary antifungal treatment options respectively.

Several isolates displayed multi drug resistance patterns underscoring the mounting challenge of managing these infections and the critical need for improved antifungal stewardship guidelines.

Dr Fahmida Chowdhury who leads the AMR Research Unit within the Infectious Diseases Division at icddr,b and served as principal investigator emphasized that Candida auris extends beyond neonatal intensive care representing a broader risk across all critical care environments.

She noted clear evidence of hospital based transmission combined with elevated resistance to standard antifungal agents necessitating urgent improvements in infection prevention enhanced surveillance systems and more judicious treatment approaches.

Genetic analysis of selected samples confirmed the strains belong to a South Asian variant of C auris indicating the fungus has become endemic to the region rather than representing sporadic imported cases.

Researchers advocate for regular comprehensive environmental cleaning using effective chlorine based disinfectants rigorous hand hygiene compliance among medical staff and routine screening in high risk units enabling early identification of colonized patients.

They emphasize prudent antifungal medication use to preserve the effectiveness of remaining viable treatment options.

The study authors acknowledge that expanded research involving additional hospitals is necessary to determine the complete scope of contamination throughout the city and nation.