A medical illustration of Candida sp. fungal organisms. (Photo courtesy of the CDC Public Health Image Library)
Reporters looking to write about the next chapter in antimicrobial resistance should get up to speed on fungal infections.
“The future is going to be a fungal problem,” said Tom Chiller, M.D., M.P.H.T.M., chief of CDC’s mycotic diseases branch, during the “Antimicrobial resistance during and after COVID-19” panel at Health Journalism 2022 in Austin.
Fungi are spore-producing organisms like yeast, molds and mushrooms. About 100 of them are known to cause disease in humans. Deadly antimicrobial resistant fungal infection cases, already rising in nursing homes and hospitals before the pandemic, accelerated during the past two years, according to the CDC.
Hospital overuse of antibiotics, especially during the first year of the pandemic when there were few options for treating patients, plus the use of steroids to treat lung inflammation caused by COVID-19, both contributed to increases in resistant fungal infections with high mortality rates.
“COVID … introduced a bit of an unfortunate perfect storm” that enabled more and broader transmission of fungal infections in hospitals, Chiller said.
In 2017, according to the most recent CDC data, 75,000 people were hospitalized in the U.S. for fungal infections, but that’s likely an underestimate. These infections often go undiagnosed and there is no national public health surveillance of common fungal infections, according to the CDC. Globally, about 13.5 million severe fungal infections — and 1.6 million deaths — are reported annually to public health officials, according to the non-profit Global Action for Fungal Infections.
During the past two years, the CDC has documented a rising number of illnesses connected to COVID-19 cases, caused by three resistant fungal infections: pulmonary aspergillosis (infections caused by the fungus Aspergillus), mucormycosis (often called by the misnomer black fungus because of its appearance) and Candida auris, an emerging and severe yeast infection that has been found in long-term care facilities.
“We didn’t know what was happening with a lot of these pathogens” because antibiotic resistance screening had become a lower priority during COVID-19 surges, Chiller said. When screening resumed “quite a bit” of resistant fungal infections were found “in places where there weren’t any before and that was certainly alarming to us.”
Patients at greatest risk of acquiring a resistant pathogen include those with chronic conditions or compromised immune systems. Yet in many health care settings, providers aren’t screening for fungal infections because it hasn’t been a traditional source of resistant infections, he said.
Bacterial resistance to drugs has existed since antimicrobials came into widespread medical use in the 1940s. Pathogens naturally evolve to resist drugs. But the scientific and economic challenges of developing new antimicrobials has led to a steep decline in the availability of new classes of antibiotics even as antimicrobial resistance has spread. In the 1950s, drug companies introduced at least nine new types of antibiotics. Since 1984, there have been no new registered classes of antibiotics. That lack of new drugs along with the spread of resistant pathogens, is leading to new dangers. As of 2019, at least 2.8 million people in the U.S. contracted an antimicrobial-resistant pathogen, and at least 35,000 died.
To counter resistant germs, researchers have been looking for options other than antibiotics. One strategy is to make use of bacteriophages — viruses that specifically kill bacteria. To help a patient, researchers engineer a phage to target a specific bacteria in the body. It has been shown to be successful in a number of patients.
Panelist Sabrina Green, Baylor College of Medicine director of research at BCM TAILOR Service Center, told AHCJ members that her nonprofit located within Baylor has developed phage treatment for about a dozen patients with resistant infections that had no option.
In one case, Green’s team developed a bacteriophage to treat a 56-year-old male liver transplant patient who had developed chronic prostate and urinary tract infections caused by resistant E. coli and his illness resolved.
“We are trying to reach out to everyone,” said Green. “Journalists, regulatory agencies, clinicians, pharmacists, so they know that we exist, and we can help more people.”
Other panelists included Morgan Scott, professor of epidemiology in the department of veterinary pathobiology at Texas A&M, who discussed how antibiotic resistance is spreading through overuse in food animal farming and Rama Thyagarajan, M.D., a University of Texas at Austin Dell Seton Medical Center infection preventionist who spoke about antibiotic stewardship at hospitals.
