C. Auris Poses Risks in the Dental Setting
Proper hand care and pretreatment mouthrinses can reduce the probability of fungal spread
Recently I received a call from a long-time patient who reported that her husband was hospitalized with Candida auris, a fungal infection. She is a healthcare professional and was concerned about possible transmission of the infection to her and her family. One of her concerns was that during hospital visits with her spouse, she had not been required to wear personal protective equipment (PPE). The United States Centers for Disease Control and Prevention’s (CDC) website provides abundant information on the pathogen, including the need for routine use of PPE in these cases.1
C. auris was first identified in Japan in 2009 where it was isolated from external ear canal discharge. Since then, it has been found in several countries including the US. Tracking this fungus has been particularly difficult because it cannot be identified using standard tests. However, the CDC reports that appropriate testing is critical to allow the initiation of measures aimed at reducing transmission of the fungus. Transmission is especially devastating to debilitated patients who receive procedures that break the integument, resulting in a bloodborne infection. The mortality rate for these systemic infections is one in three. Treatment is complicated because the fungus is resistant to all three major classes of antifungal medications.
Many of the outbreaks have involved patients with multiple healthcare co-morbidities who have not had previous antifungal treatment. This suggests transmission of resistant strains, which led the CDC to emphasize the need for susceptibility testing anytime the fungus is suspected.
Unfortunately, the clinical presentation of C. auris is similar to that of other Candida infections. Most of the C. auris cases are found in long-term healthcare facilities where they are easily transmitted. Patients can have long-standing colonies on their skin or in their nose or mouth as well as other sites. The fungus can live on patients for months and can withstand many disinfectants commonly used in healthcare settings.
Many of the strategies routinely employed in dentistry help protect our patients and staff from these fungal infections. The use of appropriate PPE is vital to reduce transmission. Proper hand care and pretreatment mouthrinses can also reduce the probability of fungal spread. Chlorhexidine — used both as a pretherapeutic mouthrinse and for hand washing — has been shown to be effective against C. auris. A 1-minute vigorous oral rinse before dental procedures is very effective in reducing or eliminating spores.2 These measures are particularly important when dental procedures are performed that could result in the introduction of the fungus into the systemic circulation. These cases are rare but when discovered early and referred to appropriate health professionals, morbidity and mortality can be reduced.
Thomas G. Wilson Jr., DDS
Editor in Chief
twilson@belmontbusinessmedia.com
References
- United States Centers for Disease Control and Prevention. Candida auris. Available at: cdc.gov.fungal.candida-auris. Accessed December 5, 2023.
- Ku TSN, Walraven CJ, Lee SA. Candida auris: disinfectants and implications for infection control. Front Microbiol. 2018:9:726.
From Decisions in Dentistry. Jan/Feb 2024; 10(1)8:
