Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal Susceptibility, and Infection Control Measures to Combat the Spread of Infections in Healthcare Facilities

Abstract

Candida auris, a recently recognized, often multidrug-resistant yeast, has become a significant fungal pathogen due to its ability to cause invasive infections and outbreaks in healthcare facilities which have been difficult to control and treat. The extraordinary abilities of C. auris to easily contaminate the environment around colonized patients and persist for long periods have recently resulted in major outbreaks in many countries. C. auris resists elimination by robust cleaning and other decontamination procedures, likely due to the formation of ‘dry’ biofilms. Susceptible hospitalized patients, particularly those with multiple comorbidities in intensive care settings, acquire C. auris rather easily from close contact with C. auris-infected patients, their environment, or the equipment used on colonized patients, often with fatal consequences. This review highlights the lessons learned from recent studies on the epidemiology, diagnosis, pathogenesis, susceptibility, and molecular basis of resistance to antifungal drugs and infection control measures to combat the spread of C. auris infections in healthcare facilities. Particular emphasis is given to interventions aiming to prevent new infections in healthcare facilities, including the screening of susceptible patients for colonization; the cleaning and decontamination of the environment, equipment, and colonized patients; and successful approaches to identify and treat infected patients, particularly during outbreaks.

Epidemiology of Candidemia in Kuwait: A Nationwide, Population-Based Study

“…Due to the lack of defined breakpoints, isolates showing an MIC ≤ 1.0 μg/mL for amphotericin B were taken as wild-type, and isolates with MIC > 1 μg/mL were scored as non-wild-type [ 37 ]. Since there are no established C. auris -specific susceptibility breakpoints, tentative MIC breakpoints of ≥32 µg/mL for fluconazole, ≥2 µg/mL for voriconazole, ≥4 µg/mL for caspofungin, and ≥2 µg/mL for amphotericin B (Etest MIC of 1.5 µg/mL was rounded off to 2.0 µg/mL), based on expert opinion, were used [ 22 , 38 ].…”

“…Candida non- albicans species are associated with even higher rates of mortality and a higher frequency of resistance to antifungal drugs than what is seen with C. albicans infections [ 6 , 7 , 14 , 19 , 20 , 21 ]. More recently, the emergence and rapid spreading of the often multidrug-resistant Candida auris has dramatically changed the epidemiology of candidemia at many geographical locations/health care facilities as it has become the most common or one of the more common causes of invasive Candida infections [ 22 ].…”

“…also varies in population-based studies carried out in different countries/geographical settings [ 6 , 8 , 17 , 23 ]. Although C. albicans is the most frequently isolated species, the number of candidemia cases caused by C. parapsilosis, C. glabrata, and C. tropicalis vary considerably, while C. auris has recently become a major pathogen in some healthcare facilities/geographical locations [ 5 , 6 , 7 , 8 , 17 , 22 , 23 ]. C. glabrata is the second, while C. parapsilosis is the third most frequently isolated species from candidemia patients in North America, Australia, and some European countries [ 5 , 6 , 7 , 8 , 17 , 23 ].…”

“…C. tropicalis invasive infections are more common in some Asian settings/countries and patients with these infections are more likely to have hematologic malignancy, neutropenia, or exposure to corticosteroids [ 6 , 8 , 17 , 24 ]. C. auris has caused invasive infections and outbreaks in more than 45 countries worldwide and unlike other Candida spp., which predominantly originate from the gastrointestinal tract, it readily colonizes the skin, is shed into the environment, and is easily transmitted to other hospitalized patients [ 8 , 22 ]. C. auris mostly causes invasive infections in older, critically ill patients with indwelling catheters, multiple comorbidities, and prolonged hospitalization [ 27 , 28 ].…”

Candida auris: A Quick Review on Identification, Current Treatments, and Challenges

“…In addition, it rapidly colonizes abiotic surfaces, immunosuppressed individuals, and causes invasive infections that exact a high toll [ 7 , 14 , 15 , 16 , 17 , 18 , 19 ]. Studies have demonstrated that the Hog1-related stress-activated protein kinase (SAPK) signaling pathway has a central role in the C. auris reaction to osmotic stress, and it is a crucial virulence factor in several human fungi [ 1 , 2 ].…”