THERE IS A NEW "BUG" IN TOWN
Katherine M. Newnam, PhD, RN, NNP-BC CPNP, IBCLE
It is well understood that invasive candidiasis is a leading cause of morbidity and mortality in the extremely low birth-weight infant.1 Fungal infections reportedly affect 4% to 7% of preterm infants with a birth weight under 1000 g. Mortality rates range from 20% to 38% (mean 30%), with significant neurodevelopmental morbidity reported in those surviving infants.1 Risk factors for candidiasis in the neonatal population include prematurity, low birth weight, antibiotic exposure, and the neonatal intensive care environment.2 Imagine the concern related to an emerging resistant strain of Candida.
Japan issued the first report of Candida auris in 2009. This new species was identified through sequence analysis of the nuclear rRNA gene. Phylogenetically related to Candida haemulonii, 15 patients were later identified in South Korea with an approximately 40% mortality rate.3 The new strain spread to New Delhi, India, which described 12 inpatients from 2 different hospitals over a 2-year time frame (2009-2011). Four of the 12 patients were low birth-weight infants.3 This new clonal strain is multidrug resistant and appears genotypically distinct from other strains. As with most Candida strains, this fungus is opportunistic, with immunocompromised patients most at risk.
With the rapid spread to numerous countries in the Middle East, Africa, Europe, and East Asia, the United States has identified 13 cases to date.4 Seven of these cases are from 4 states, New York, Illinois, Maryland, and New Jersey. Reportedly, these patients in the United States were immunocompromised with extended hospital stays. The Centers for Disease Control and Prevention (CDC) reports the possible spread of this organism within the healthcare setting.4
C auris is now described by the CDC as "a global health threat," as this strain has proven resistance to all 3 major classes of antifungal drugs. Other Candida strains have proven resistance to some therapy, but this is the first truly multidrug-resistant yeast.5 Recommendations for healthcare professionals include implementation of strict contact precautions to control the spread of the organism. Obviously, strict hand hygiene to protect our vulnerable patients and ourselves is paramount.4
1. Benjamin DK, Stoll BJ, Gantz MG, et al Neonatal candidiasis: epidemiology, risk factors and clinical judgement. Pediatrics. 2010;126(4):e865-e873. [Context Link]
2. Kelly MS, Benjamin DK, Smith PB. The epidemiology and diagnoses of invasive candidiasis among premature infants. Clin Perinatol. 2015;42(1):105-117. doi:10.1016/j.clp.2014.10.008. [Context Link]
3. Chowdhary A, Sharma C, Duggal S, et al New clonal strain of Candida auris, Delhi, India. Emerg Infect Dis. 2013;19(10):1670-1673. [Context Link]
4. Drug-resistant Candida auris reported in the United States. http://http://www.aafp.org/news/health-of-the-public/20161115candidaauris.html. Accessed April 28, 2017. [Context Link]
5. Clinical alert to US healthcare facilities-June 2016. https://http://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-alert.html. Accessed April 28, 2017. [Context Link]
NANN DELEGATION TO CUBA
Pamela Harris-Haman, DNP, CRNP, NNP-BC
On March 13-18, 2017, a group of 13 individuals from across the United States represented the National Association of Neonatal Nurses (NANN) as delegates to Cuba. NANN was invited to visit the country by the Cuban Nursing Society. The opportunity to represent our organization and the United States as delegates to this beautiful country was a once-in-a-lifetime opportunity.
The group arrived in Havana on March 13 and was warmly greeted by the ATA representative Amircal Salermo. The US representative was Stacy Ramirez. We spent the first day touring Havana and the El Morro Castle. Tuesday began our meetings with representatives of various Cuban healthcare organizations. Our initial meeting was with the Cuban Nursing Society, where we discussed the role of nurses within the Cuban healthcare system. We were invited to visit the Ramon Gonzalez Coro Hospital. During this tour, we were able to talk with nurses about the role of nurses and typical newborn care. Following the discussion, we were able to tour the neonatal intensive care unit (NICU).
The National School of Public Health invited us for a panel discussion on infant care and issues facing hindrances to breastfeeding. During this discussion, we were able to glimpse the passion the Cuban people have for each other and their patients. During the afternoon, we visited a policlinico (polyclinic) to see firsthand how the healthcare system in Cuba operates. The policlinico is the primary center of care serving patients with a variety of clinics from maternity to geriatric care. We then traveled to see the family doctor/nurse at the consultorio (consulting). Each individual in Cuba is assigned to a family doctor and a nurse who are responsible to oversee the healthcare needs of up to 1500 patients. Each family doctor/nurse unit is required see each patient in the office annually and performs a yearly home visit.
On Friday, we were able to visit the Cuerpo de Guardia, Hospital Universitario Materno. Dr Cocoa, one of the neonatologists, spent time discussing the healthcare needs and treatment of infants in the NICU and the various levels of hospitals within the Cuban health system. She then proudly allowed us to visit her NICU and talk with parents and nurses. The delegation was treated to a tour of their state-of-the-art milk bank.
Our last hospital tour was of a maternity hospital, "Hospital de obstetricia y ginecologia," where mothers are admitted for complications including poor glucose control, premature labor, and other health issues. We were able to enjoy many wonderful restaurants and sights on our visit. The delegation was able to network with Cuban nursing professionals, which will hopefully lead to future collaborations. Most impressive was the compassion, much like our own, that the nurses felt for their patients. The nurses in Cuba face many challenges due to lack of resources. Yet, these professionals are fiercely passionate about nursing and the patients they care for.