A drug-resistant ‘superbug’ spreading in Dhaka ICUs: icddr,b study

A hard-to-treat drug-resistant fungus known as Candida auris is spreading within intensive care units (ICUs) in Dhaka, according to a study conducted by icddr,b.

The findings show that this “superbug” is not limited to newborn units, but is also affecting other critically ill patients, raising concerns about hospital-acquired infections.

Earlier research had shown the fungus spreading among newborns in intensive care unit (NICU), and the new findings suggest the problem is broader and affects other ICU settings as well, icddr,b said in a press release today.

Candida auris can colonise and live on the skin without causing symptoms. However, in some patients, it can enter the bloodstream and cause severe and life-threatening infection.

The fungus is especially alarming for people who are critically ill or have weak immune systems. It is also difficult to treat because almost all strains are resistant to commonly used anti-fungal medicines. For these reasons, health authorities around the world consider C. auris a serious healthcare-associated threat.

In total, 372 ICU patients were included in the study between August 2021 and September 2022.

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The study, published in the journal Microbiology Spectrum, was carried out in one public and one private tertiary-level hospital in Dhaka, in collaboration with the Institute of Epidemiology, Disease Control and Research (IEDCR),

United States Centers for Disease Control and Prevention (CDC) provided technical support.

Researchers tested patients soon after admission and again during their ICU stay to see whether they were carrying Candida auris on their skin or had developed a bloodstream infection.

Skin swabs and blood samples were analysed in the laboratory, and suspected samples were confirmed using VITEK-2.

In this study, about 7 percent of patients were found to be carrying C. auris at some point during their ICU stay.

Importantly, more than one-third of the patients who were found to be carrying the fungus picked it up during their stay in the ICU, showing that the fungus is spreading mostly inside hospital settings.

The researchers also found that this happened more often in public hospitals than in private hospitals, with about 13 percent of patients picking up the fungus during their ICU stay in public hospitals compared to about 4 percent in private hospitals, pointing to possible differences in infection prevention and control practices.

“This study shows that Candida auris is not just a problem among critically ill neonates, but a wider threat in all intensive care settings,” said Fahmida Chowdhury, lead of the AMR Research Unit of the Infectious Diseases Division at icddr,b and principal investigator of this research project.

“We are seeing clear signs of spread within hospitals and high levels of resistance to commonly used anti-fungal drugs. This underlines the urgent need to strengthen infection prevention, improve surveillance, and guide treatment more carefully.”

The researchers recommend regular and thorough cleaning of hospital environments using effective chlorine-based disinfectants, strict hand hygiene among healthcare workers, and routine screening in high-risk units so that patients carrying the fungus can be identified early.

They also stress the importance of careful use of anti-fungal medicines, so that the few effective treatments available remain useful for as long as possible.

The researchers note that larger studies in more hospitals will be needed to understand the full scale of the problem across the city and the country.