Candida auris: A Review of Recommendations for Detection and Control in Healthcare Settings

Abstract

Candida auris is an emerging multidrug-resistant fungal pathogen. Since first reported in 2009, C. auris has caused healthcare outbreaks around the world, often involving high mortality. Identification of C. auris has been a major challenge as many common conventional laboratory methods cannot accurately detect it. Early detection and implementation of infection control practices can prevent its spread. The aim of this review is to describe recommendations for the detection and control of C. auris in healthcare settings. most common misidentifications based on frequently used yeast identification methods [5,6]. However, efforts to improve C. auris identification methods have made substantial progress in the last few years. The development of a high-salt, high-temperature enrichment culture-based method has made it possible to reliably isolate C. auris from complex sample types [7][8][9]. Once an isolate is obtained, identification of C. auris can be efficiently accomplished with matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. For MALDI-TOF identification, it is important to ensure C. auris is in the reference database [5,6,10]. The Bruker Biotyper (Bruker Daltonik GmbH, Bremen, Germany) and the VITEK MS (bioMérieux, Marcy, L'Etoile, France) include C. auris in their Research Use Only and certain versions of their FDA-approved system databases [3,5,11]. If MALDI-TOF is not available, laboratories can reliably identify an isolate by sequencing the D1-D2 region of the 28s rDNA or the internal transcribed spacer (ITS) regions of rDNA [12][13][14].

A Cluster of Candida auris Blood Stream Infections in a Tertiary Care Hospital in Oman from 2016 to 2019

“…Gaps in risk assessment for C. auris were not included in the institutional screening protocol during this period, which might have caused epidemiological links in our clinical setting to be missed. A proper screening protocol and risk assessment policy will strengthen infection control measures to prevent C. auris infection from becoming a major problem in the future [ 40 , 41 ].…”

Detection and Control of Fungal Outbreaks

“…The sources of healthcare-associated outbreaks include construction near or renovation of healthcare facilities, contamination of water and ventilation systems, medicines and medical devices, and gaps in infection prevention measures [ 9 – 12 , 14 , 15 ]. An increasingly reported cause of fungal outbreaks is the emergence of novel resistant pathogens within hospital environments, clearly exemplified by the unprecedented emergence of Candida auris , as well as increasing incidence of previously rare resistant species like Candida krusei and Diutina rugosa [ 16 – 19 ].…”

Ibrexafungerp: A Novel Oral Triterpenoid Antifungal in Development for the Treatment of Candida auris Infections

“…Timely and accurate diagnosis of invasive candidiasis are important for early initiation of antifungal therapy, while species identification is critical to ensure implementation of infection control measures [ 1 , 6 , 10 , 11 ]. Acceptable standard diagnostic methods for C. auris identification include matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) and VITEK2™ with the appropriate updated databases and DNA sequencing [ 7 , 12 ].…”