Drug-Resistant Fungus Spreading in Hospitals: Is it Last of Us?

Here's a scenario that may sound familiar to fans of the postapocalyptic TV drama The Last of Us: a hard-to-kill fungus is beginning to spread among-and infect-vulnerable populations. Only this time, it's real.

A multidrug-resistant fungus is rapidly advancing in hospitals and healthcare facilities, posing a serious risk of infection for patients. Unlike the cordyceps in the video game-turned-HBO hit show, this fungus, Candida auris, isn't turning people into zombies. But it's still a serious threat, and one that researchers need to heed sooner rather than later, says Kevin Outterson, executive director of CARB-X, a Boston University-led nonprofit funding the world's most scientifically diverse, early development pipeline of new antibiotics and vaccines.

Photo of Kevin Outterson, Executive Director, CARB-X. Outterson sits in a blue armchair with hands folded in front of him as he poses fort he camera. He wears a navy blazer, jeans, and a light purple collared shirt.
Kevin Outterson, executive director of CARB-X, a BU-led partnership to combat antimicrobial resistance. Photo by Cydney Scott

"This may not take over the country like The Last of Us and cause a zombie apocalypse tomorrow, but it's the sort of thing that if we want to have a new solution in a decade, then researchers need to have started last week," says Outterson, who is also the BU School of Law Austin B. Fletcher Professor of Law and codirector of the health law program.

Clinical cases of infections caused by C. auris almost doubled in 2021, according to research published this month in the Annals of Internal Medicine. And the number of cases resistant to echinocandins, the first-line treatment for C. auris infections, tripled. While the fungus generally isn't a threat for healthy people, it can be dangerous for those with weakened or compromised immune systems, and people using feeding tubes or catheters-in other words, a large proportion of patients in hospitals. The fungus can cause a bloodstream infection whose symptoms include fever, chills, sweats, and low blood pressure. It's still rare in the US, but roughly one in three patients with an invasive infection will die from it; the fungus poses an "urgent threat," according to the US Centers for Disease Control and Prevention.

The Brink spoke to Outterson about the threat that C. auris poses, and what we need to do to prevent future drug-resistant outbreaks.

Image: Promotional image for the HBO drama series
Outterson says this fungus isn't going to make him "start wearing a hazmat suit and stocking up food in my basement" like in HBO's The Last of Us (above), but it's an urgent problem for researchers to untangle. Image courtesy of HBO

This interview was edited for clarity and brevity.

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