CATES: A look at drug resistant fungal infections


By Carol A. Cates, MSN, MBA, RN

Chief Nursing Officer

Odessa Regional Medical Center

When I was a young nurse, the only option we had for treating bad fungal infections was a drug called Amphotericin B. This drug had so many awful side effects and caused so many allergic reactions, those of us in healthcare often referred to it as “amphoterrible”. One of the silver linings of the HIV epidemic is that it helped spur the development of better anti-fungal medications. Fast-forward 25 years, and we are now in a place where some fungi have become resistant to many of the anti-fungal medications, making them even harder to treat than back in the day when Amphotericin B was one of the few options.

One of those fungal infectious agents, a yeast called Candida auris (C. auris), has been in the news quite a bit in the last couple weeks because it seems to be spreading at faster than normal rates. This is concerning because C. auris is resistant to many anti-fungal medications, and it can cause very severe illness in people with weakened immune systems. C. auris is not a threat to people with normal immune systems, and many people carry it on their skin without even knowing about it. The people that seem to be at the highest risk for C. auris infections are immunocompromised individuals that reside in long-term care facilities. Symptoms of fungal infections most commonly include itching, red and flaking skin, and burning sensations when voiding. A fungal respiratory infection has similar symptoms to other respiratory infections.

The good news about fungal infections is they can be prevented, and many of the same practices that prevent fungal infections help us prevent all infections. First and foremost, the best prevention is good handwashing. 20 seconds of scrubbing with soap and water is best, if soap and water is not available, use a good quality hand sanitizer to wash your hands.

Fungi thrive in moist environments so keep yourself as clean and try as possible. Make sure clothes are clean and dry. Do not re-wear clothes between washing. This is particularly true for underwear and socks. Avoid tight clothes, tight shoes, and non-breathable fabrics because those conditions make it harder for sweat to evaporate.

Bathe or shower daily and after any strenuous activity that causes excessive sweating. If you can’t bathe or shower after strenuous activity, change out of any damp clothes and make sure your skin is kept dry until you can bathe or shower. After bathing or showering make sure your skin is dry, particularly in areas where fungi like to thrive, such as skin folds, in the genital area, and between the toes.

Keep nails short and clean, make sure you are cleaning under and around nails when handwashing. Avoid sharing nail clippers and any other nail tools. Avoid sharing towels and other personal items with others, as this can spread fungal infections. Wipe down shared surfaces with disinfectants.

Avoid being barefoot, particularly in common areas that can harbor fungi, such as gyms and locker rooms. Diets rich in fruits and vegetables, low in sugar, and that include probiotics also help fight fungal infections. For those that are diabetic, keeping blood sugar under control will also help keep bacteria and fungi under control and prevent infection.

If you have a fungal infection, it’s particularly important that you follow the above recommendations to keep the infection from spreading to others.

If you or a loved one are hospitalized or in long-term care, remember to be your own infection control advocate. It is okay to ask doctors, nurses, and other health care professionals if they have washed their hands. Ask your health care providers about removing any tubes (catheters) or other devices as soon as medically possible.

Tubes that enter the body can make it easier for bacteria and fungi to enter the body as well, so the fewest number of tubes for the shortest possible time is always best. Ask your health care provider if there are non-invasive options for any tubes that are medically needed. For instance, rather than having a Foley catheter (a tube that enters the bladder through the urethral opening in the genital region), a device called a soft wick for women or a condom catheter for men, can be good options for controlling urine incontinence.

Keep wounds clean and dry and seek medical attention if they don’t heal within a week or two or have any drainage.

Finally, if you suspect you have a fungal infection or any other kind of infection, talk to your primary health care provider as soon as possible. Fungal infections, just like so many conditions, are easier to treat when they are discovered early.