Candida aurisIsolates Resistant to Three Classes of Antifungal Medications — New York, 2019

Abstract

Candida auris is a globally emerging yeast that causes outbreaks in health care settings and is often resistant to one or more classes of antifungal medications (1). Cases of C. auris with resistance to all three classes of commonly prescribed antifungal drugs (pan-resistance) have been reported in multiple countries (1). C. auris has been identified in the United States since 2016; the largest number (427 of 911 [47%]) of confirmed clinical cases reported as of October 31, 2019, have been reported in New York, where C. auris was first detected in July 2016 (1,2). As of June 28, 2019, a total of 801 patients with C. auris were identified in New York, based on clinical cultures or swabs of skin or nares obtained to detect asymptomatic colonization (3). Among these patients, three were found to have pan-resistant C. auris that developed after receipt of antifungal medications, including echinocandins, a class of drugs that targets the fungal cell wall. All three patients had multiple comorbidities and no known recent domestic or foreign travel. Although extensive investigations failed to document transmission of pan-resistant isolates from the three patients to other patients or the environment, the emergence of pan-resistance is concerning. The occurrence of these cases underscores the public health importance of surveillance for C. auris, the need for prudent antifungal prescribing, and the importance of conducting susceptibility testing on all clinical isolates, including serial isolates from individual patients, especially those treated with echinocandin medications. This report summarizes investigations related to the three New York patients with pan-resistant infections and the subsequent actions conducted by the New York State Department of Health and hospital and long-term care facility partners. Clinical C. auris cases were defined as those in which C. auris was identified in a clinical culture obtained to diagnose or treat disease. Screening cases were defined as those in which C. auris was identified by polymerase chain reaction testing and culture, or by culture only, of a sample from an axilla, groin, or nares swab obtained for the purpose of state public health surveillance (2). To assess ongoing colonization with C. auris, additional swabs were collected over time from patients colonized with C. auris. Wadsworth Center, the New York State public health laboratory, conducted testing to confirm presumptive C. auris isolates from various health care facilities in New York during

Candida auris Infection and Biofilm Formation: Going Beyond the Surface

“…Worldwide, nearly all isolates exhibit resistance to the triazole drug, fluconazole, and many (near 40%) show a multidrug resistance phenotype [2, 6, 11••, 38]. Reports have also revealed pan-resistant isolates that display resistance to all three commonly prescribed drug classes [39]. The additional resistance associated with biofilm growth further complicates treatment.…”

Antifungal Resistance in Candida auris: Molecular Determinants

“…One of the most studied genes to understand the resistance of C. auris to antifungals is ERG11, which encodes for lanosterol-14α-demethylase (target protein of the fungistatic action of the triazoles) [26].…”

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

“…Ostrowski and colleagues [ 18 ] described three cases of C. auris among 801 patients in New York state with confirmed C. auris that were pan-resistant, i.e., resistant to fluconazole, amphotericin B, and echinocandins. All three patients with pan-resistance were on mechanical ventilators; two died within two to four weeks from isolation of a pan-resistant C. auris , and the third died at 10 months.…”

“…Antifungal resistance with C. auris is acquired rather than intrinsic, and the primary mechanisms of resistance were characterized for echinocandins and azoles [ 8 ]. Multidrug-resistant and pan-resistant isolates of C. auris were also identified from clinical isolates [ 15 , 16 , 18 ]. Thus, a need exists for novel antifungal agents that demonstrate high levels of activity against C. auris and address these treatment gaps.…”