Navigating the New Reality: A Review of the Epidemiological, Clinical, and Microbiological Characteristics of Candida auris, with a Focus on Children

Abstract

During the past decade, Candida auris emerged across the world, causing nosocomial outbreaks in both pediatric and adult populations, particularly in intensive care settings. We reviewed the epidemiological trends and the clinical and microbiological characteristics of C. auris infection, focusing on the pediatric population. The review is based on 22 studies, which included about 250 pediatric patients with C. auris infection, across multiple countries; neonates and premature babies were the predominant pediatric patient group affected. The most common type of infection reported was bloodstream infection, which was associated with exceptionally high mortality rates. Antifungal treatment varied widely between the patients; this signifies a serious knowledge gap that should be addressed in future research. Advances in molecular diagnostic methods for rapid and accurate identification and for detection of resistance may prove especially valuable in future outbreak situations, as well as the development of investigational antifungals. However, the new reality of a highly resistant and difficult-to-treat pathogen calls for preparedness of all aspects of patient care. This spans from laboratory readiness, to raising awareness among epidemiologists and clinicians for global collaborative efforts to improve patient care and limit the spread of C. auris.

Candida auris Infection, a Rapidly Emerging Threat in the Neonatal Intensive Care Units: A Systematic Review

“…Fungemia is a condition with high mortality, often as high as 50%, while the mortality rate for C. auris is reported to be between 40 and 60% [ 4 , 6 ]. The mortality rate we documented, in the total number of neonates with C. auris infection (93 cases), for which the studies provided information concerning the outcome of the infection, was quite high (approximately 42%), a finding consistent with the high mortality rate reported in studies focused on pediatric and adult patients [ 6 , 60 ].…”

“…In recent years, we have witnessed a global change in candidemia epidemiology with the appearance of resistant, non-albicans species of Candida, with a particular emphasis on the increase in cases of C. auris infections. Candida auris is spreading globally and causing hospital infections in pediatric and adult populations, particularly in ICUs [ 58 , 59 , 60 ] and is included in the 2019 Emergency Threats Report of the Centers for Disease Control and Prevention (CDC) of the USA [ 12 ]. As is evident from the history of the discovery of this fungus, C. auris can cause severe ear infections.…”

“…However, its main threat lies on its isolation from the bloodstream. Wound and soft tissue infections, osteomyelitis, central nervous system infections, and generalized infections in immunosuppressed patients have been described in the international literature [ 60 ]. According to our systematic review, we located 24 publications [ 23 , 24 , 25 , 32 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ] from 2013 until today, in which 476 cases of C. auris infections are reported.…”

“…However, it is noteworthy that, among the overall number of infants with reported gestational age, 64.5% were premature, suggesting that prematurity, as in other cases of IFI, is one of the main contributing factors to C. auris infection. Apart from prematurity, other contributing factors noted were the administration of total parenteral nutrition, the insertion of umbilical or other central lines, mechanical ventilation and prior administration of broad-spectrum antibiotics, which were also recognized in adult and pediatric patients with C. auris infection [ 60 , 61 , 62 ]. From the total number of patients with available data concerning underlying health problems, 33.3% had congenital heart disease, 23.8% had congenital gastrointestinal malformations, and 9.5% had necrotizing enterocolitis.…”

A Candida auris –specific adhesin, Scf1 , governs surface association, colonization, and virulence

“…ince the initial reports of its discovery in 2009, the emerging fungal pathogen Candida auris has become an increasingly common source of life-threatening infection worldwide (1,2). C. auris is frequently reported in association with nosocomial outbreaks, a characteristic rarely described with other Candida species, and is of urgent concern for public health authorities (3)(4)(5)(6)(7). C. auris outbreaks are characterized by persistent colonization of patient skin and abiotic surfaces, which can remain positive for extensive periods and serve as a source of contaminative transmission (8)(9)(10)(11)(12)(13)(14).…”