Candida auris : An emerging multidrug-resistant pathogen

Abstract

Candida aurisis an emerging multidrug-resistant pathogen that can be difficult to identify using traditional biochemical methods. C. auris is capable of causing invasive fungal infections, particularly among hospitalized patients with significant medical comorbidities. Echinocandins are the empiric drugs of choice for C. auris, although not all isolates are susceptible and resistance may develop on therapy. Nosocomial C. auris outbreaks have been reported in a number of countries and aggressive infection control measures are paramount to stopping transmission.

Emerging Infectious Diseases

“…The fungus spread through international travel most notably in New York and New Jersey, causing outbreaks in health care facilities. 20,23,24 Clinical manifestations of C auris include invasive infections with a high mortality from bloodstream infections in patients with serious underlying comorbidities and indwelling devices. Of the 51 persons with the infection in New York from 2013 to 2017, 23 the major concurrent condition (65%) was respiratory insufficiency.…”

“…Because of the misidentification, the CDC recommends specific testing methods when select yeast organisms have been reported, for example, Candida haemulonii, another emerging drug-resistant strain. 24 Adults should be suspect if they had overnight admissions to health care facilities in affected areas (eg, India, Pakistan, South Africa, Kenya). Clinicians must work with local health departments if infection with this fungus is a possibility.…”

An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital

“…Although there are no established breakpoints for C. auris , studies have demonstrated elevated resistance to azoles with minimum inhibitory concentration (MIC) 256 μg/mL and ≥2 μg/mL to fluconazole and voriconazole, respectively, and variable susceptibility to other azoles, amphotericin B and echinocandins . Finally, delay in species identification, presence of comorbidity and clinical severity of infected patients (critical care patients) and antifungal resistance lead to high mortality rates and presence of frequent complications (septic metastasis and recurrent/persistent candidaemia) . Therefore, C. auris infections are a worrisome healthcare problem and a daily challenge for the clinician dealing with infected or colonised patients.…”

“…4,6,21,22 Finally, delay in species identification, presence of comorbidity and clinical severity of infected patients (critical care patients) and antifungal resistance lead to high mortality rates and presence of frequent complications (septic metastasis and recurrent/persistent candidaemia). 13,23 Therefore, C. auris infections are a worrisome healthcare problem and a daily challenge for the clinician dealing with infected or colonised patients.…”

Assessment of Environmental and Occupational Exposure while Working with Candida auris a Multidrug Resistant (MDR) Fungus in the Animal Facility.

“…To mitigate these potential exposures, we implemented a rigorous "buddy system" workflow and a disinfection protocol that uses 10% bleach followed by 70% ethanol and can be used in any animal facility when using small animal models of C. auris infection.Since its identification in 2009, the emerging fungal pathogen Candida auris has become a major public health threat, due to its status as a multidrug resistant (MDR) fungus with high levels of resistance to an already limited arsenal of antifungals, such as the azoles and polyenes. (1)(2)(3)(4) Minimal inhibitory concentrations (MICs) for antifungals used against C. auris have been reported to be as high as 256 mg/L for fluconazole and > 2 mg/L for amphotericin B. (1-5) The Centers for Disease Control (CDC) has documented that C. auris behaves more like transmissible bacterial multidrug resistant organisms (MDROs) such as methicillin resistant Staphylococcus aureus (MRSA) than any other Candida species.…”