Advertisement

Candida auris: What We Need to Know in Healthcare Settings

  • Cima Nowbakht
  • Luis Ostrosky-Zeichner
Treatment and Prevention of Hospital Infections (D Vilar-Compte, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Treatment and Prevention of Hospital Infections

Abstract

Purpose of review

Candida auris is an emerging pathogen characterized for its difficult identification, rapid nosocomial spread, and limited treatment options. Data is currently limited; however, this will change as the pathogen’s prevalence increases. The goal of this review is to provide a concise summary of the available data to manage a possible C. auris infection.

Recent findings

Candida auris has been rapidly spreading globally and has been evading popular identification methods with MALDI-TOF being the only successful modality as long as the “research use only” database is used. Echinocandins are the treatment of choice; however, all isolates should have susceptibilities performed as there have been reports of resistance to all antifungal classes. Several hospital outbreaks have occurred; thus, all patients should be isolated with appropriate terminal cleaning.

Summary

Atypical or suspicious Candida isolates should be identified by MALDI-TOF. Most Candida auris strains are resistant to azoles; therefore, the suggested empirical treatment is an echinocandin. Echinocandin-resistant strains have been reported, and in those cases, a polyene is preferred. Strict contact precautions are recommended while in the hospital due to high levels of nosocomial transmission.

Keywords

Candida auris Epidemiology Candidemia Infection control Nosocomial transmission 

Notes

Funding information

No funding.

Compliance with ethical standards

Conflict of interest

Cima Nowbakht declares that she has no conflict of interest. Luis Ostrosky-Zeichner has received research grants and/or consulting honoraria and lecture fees from Merck, Pfizer, Astellas, Scynexis, and Cidara.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Deorukhkar SC, Saini S, Mathew S. Non-albicans Candida infection: an emerging threat. Interdiscip Perspect Infect Dis. 2014;2014:615958.  https://doi.org/10.1155/2014/615958.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol. 2009;53:41–4.  https://doi.org/10.1111/j.1348-0421.2008.00083.x.CrossRefPubMedGoogle Scholar
  3. 3.
    Kim MN, et al. Candida haemulonii and closely related species at 5 university hospitals in Korea: identification, antifungal susceptibility, and clinical features. Clin. Infect. Dis. 2009;48:e57–61.CrossRefPubMedGoogle Scholar
  4. 4.
    Lee WG, et al. First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol. 2011;49(9):3139–42.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Vallabhaneni S, Kallen A, Tsay S, Chow N, Welsh R, Kerins J, Kemble SK, Pacilli M, Black SR, Landon E, Ridgway J, Palmore TN, Zelzany A, Adams EH, Quinn M, Chaturvedi S, Greenko J, Fernandez R, Southwick K, Furuya EY, Calfee DP, Hamula C, Patel G, Barrett P, Lafaro P, Berkow EL, Moulton-Meissner H, Noble-Wang J, Fagan RP, Jackson BR, Lockhart SR, Litvintseva AP, Chiller TM. 2016. Investigation of the first seven reported cases of Candida auris, a globally emerging invasive, multidrug-resistant fungus—United States, May 2013–August 2016. MMWR Morb Mortal Wkly Rep 65:1234–1237.  https://doi.org/10.15585/mmwr.mm6544e1.
  6. 6.
    Lockhart SR, Etienne KA, Vallabhaneni S, Farooqi J, Chowdhary A, Govender NP, Lopes Colombo A, Calvo B, Cuomo CA, Desjardins CA, Berkow EL, Castanheira M, Magobo REE, Jabeen K, Asghar RJ, Meis JF, Jackson B, Chiller T, Litvintseva AP. 2017. Simultaneous emergence of multidrug resistant Candida auris on 3 continents confirmed by whole-genome sequencing and epidemiological analyses. Clin Infect Dis 64:134–140.  https://doi.org/10.1093/cid/ciw691.
  7. 7.
    Emara M, Ahmad S, Khan Z, Joseph L, Al-Obaid I, Purohit P, et al. Candida auris candidemia in Kuwait, 2014. Emerg Infect Dis. 2015;21:1091–2.  https://doi.org/10.3201/eid2106.150270.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Magobo RE, Corcoran C, Seetharam S, Govender NP. Candida auris-associated candidemia, South Africa. Emerg Infect Dis. 2014;20:1250–1.  https://doi.org/10.3201/eid2007.131765.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    • Mizusawa M, Miller H, Green R, Lee R, Durante M, Perkins R, et al. Can multidrug resistant Candida auris be reliably identified in clinical microbiology laboratories? J Clin Microbiol. 2016;55:638–40.  https://doi.org/10.1128/JCM.02202-16. This study presented a detailed evaluation of the challenges that widely used biochemical devices were routinely misidentifying C. auris CrossRefPubMedGoogle Scholar
  10. 10.
    Kathuria S, Singh PK, Sharma C, Prakash A, Masih A, Kumar A, et al. Multidrug-resistant Candida auris misidentified as Candida haemulonii: characterization by matrix-assisted laser desorption ionization–time of flight mass spectrometry and DNA sequencing and its antifungal susceptibility profile variability by Vitek 2, CLSI broth microdilution, and Etest method. J Clin Microbiol. 2015;53:1823–30.  https://doi.org/10.1128/JCM.00367-15.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lockhart S, et al. Thinking beyond the common Candida species: need for speciation of Candida due to the emergence of multidrug resistant Candida auris. J Clin Microbiol. 2017;55:3324–7.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Tsay S, et al. Approach to the investigation and management of patients with Candida auris, an emerging multidrug-resistant yeast. Clin Infect Dis. 2017 Aug;17Google Scholar
  13. 13.
    Kumar A, Sachu A, Mohan K, Vinod V, Dinesh K, Karim S. Simple low cost differentiation of Candida auris from Candida haemulonii complex using CHROMagar Candida medium supplemented with Pal’s medium. Rev. Iberoam Micol. 2017;34:109–11.  https://doi.org/10.1016/j.riam.2016.11.004.CrossRefPubMedGoogle Scholar
  14. 14.
    Sandrine M, Marion C, Geraldine D, Alex VB, Ferry H, Jacques M, et al. Identification and typing of an emerging pathogen, Candida auris, by MALDI TOF MS using the vitek MS platform. Clin Chem Lab Med. 2015;53:S1321.  https://doi.org/10.1515/cclm-2015-5033.CrossRefGoogle Scholar
  15. 15.
    Girard V, Mailler S, Chetry M, Vidal C, Durand G, van Belkum A, et al. Identification and typing of the emerging pathogen Candida auris by matrix-assisted laser desorption ionization time of flight mass spectrometry. Mycoses. 2016;59:535–8.  https://doi.org/10.1111/myc.12519.CrossRefPubMedGoogle Scholar
  16. 16.
    Arendrup MC, Prakash A, Meletiadis J, Sharma C, Chowdhary A. Comparison of EUCAST and CLSI reference microdilution MICs of eight antifungal compounds for Candida auris and associated tentative epidemiological cutoff values. Antimicrob Agents Chemother. 2017;61:e00485–17.  https://doi.org/10.1128/AAC.00485-17.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Fakhim H, Chowdhary A, Prakash A, Vaezi A, Dannaoui E, Meis JF, et al. In vitro interactions of echinocandins with triazoles against multidrug-resistant Candida auris. Antimicrob Agents Chemother. 2017;  https://doi.org/10.1128/AAC.01056-17.
  18. 18.
    Lepak AJ, Zhao M, Berkow EL, Lockhart SR, Andes DR. Pharmacodynamic optimization for treatment of invasive Candida auris infection. Antimicrob Agents Chemother. 2017;61:e00791–17.  https://doi.org/10.1128/AAC.00791-17.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Kofla G, Ruhnke M. Pharmacology and metabolism of anidulafungin, caspofungin and micafungin in the treatment of invasive candidosis: review of the literature. Eur J Med Res. 2011;16:159–66.  https://doi.org/10.1186/2047-783X-16-4-159.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Chowdhary A, Sharma C, Duggal S, Agarwal K, Prakash A, Singh PK, et al. New clonal strain of Candida auris, Delhi, India. Emerg Infect Dis. 2013;19:1670–3.  https://doi.org/10.3201/eid1910.130393.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Schelenz S, Hagen F, Rhodes JL, Abdolrasouli A, Chowdhary A, Hall A, et al. First hospital outbreak of the globally emerging Candida auris in a European hospital. Antimicrob Resist Infect Control. 2016;5:35.  https://doi.org/10.1186/s13756-016-0132-5.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    European Centre for Disease Prevention and Control. Candida auris in healthcare settings—Europe. Stockholm, Sweden: European Centre for Disease Prevention and Control; 2016.Google Scholar
  23. 23.
    England PH. Guidance for the laboratory investigation, management and infection prevention and control for cases of Candida auris. United Kingdom: Public Health England; 2017.Google Scholar
  24. 24.
    Welsh RM, Bentz ML, Shams A, Houston H, Lyons A, Rose LJ, et al. Survival, persistence, and isolation of the emerging multidrug resistant pathogenic yeast Candida auris on a plastic healthcare surface. J Clin Microbiol. 2017;55:2996–3005.  https://doi.org/10.1128/JCM.00921-17.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    •• Abdolrasouli A, Armstrong-James D, Ryan L, Schelenz S. In vitro efficacy of disinfectants utilized for skin decolonisation and environmental decontamination during a hospital outbreak with Candida auris. Mycoses. 2017;60:758–63.  https://doi.org/10.1111/myc.12699. This study provides in vitro data on several current methods to disinfectant hospital environments and colonized patients CrossRefPubMedGoogle Scholar
  26. 26.
    Shackleton J, Schelenz S, Rochon M, Hall A, Ryan L, Cervera-Jackson R. 2016. The impact of environmental decontamination in a Candida auris outbreak. J Hosp Infect 94(Suppl 1):S24 –S134.  https://doi.org/10.1016/S0195-6701(16)30516-3.
  27. 27.
    Piedrahita CT, Cadnum JL, Jencson AL, Shaikh AA, Ghannoum MA, Donskey CJ. Environmental surfaces in healthcare facilities are a potential source for transmission of Candida auris and other candida species. Infect Control Hosp Epidemiol. 2017;38:1107–9.  https://doi.org/10.1017/ice.2017.127.CrossRefPubMedGoogle Scholar
  28. 28.
    Tsay S, Welsh RM, Adams EH, Chow NA, Gade L, Berkow EL, Poirot E, Lutterloh E, Quinn M, Chaturvedi S, Kerins J, Black SR, Kemble SK, Barrett PM, Barton K, Shannon DJ, Bradley K, Lockhart SR, Litvintseva AP, Moulton-Meissner H, Shugart A, Kallen A, Vallabhaneni S, Chiller TM, Jackson BR. 2017. Notes from the field: ongoing transmission of Candida auris in health care facilities—United States, June 2016–May 2017. MMWR Morb Mortal Wkly Rep 66:514–515.  https://doi.org/10.15585/mmwr.mm6619a7.
  29. 29.
    Moore G, Schelenz S, Borman AM, Johnson EM, Brown CS. The yeasticidal activity of chemical disinfectants and antiseptics against Candida auris. J Hosp Infect. 2017;  https://doi.org/10.1016/j.jhin.2017.08.019.
  30. 30.
    Sarma S, Upadhyay S. Current perspective on emergence, diagnosis and drug resistance in Candida auris. Infect Drug Resist. 2017;10:155–65.  https://doi.org/10.2147/IDR.S116229.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Sarma S, Kumar N, Sharma S, Govil D, Ali T, Mehta Y, Rattan A. 2013. Candidemia caused by amphotericin B and fluconazole resistant Candida auris. Indian J Med Microbiol 31:90–91.  https://doi.org/10.4103/0255-0857.108746.
  32. 32.
    Cadnum JL, Shaikh AA, Piedrahita CT, Sankar T, Jencson AL, Larkin EL, et al. Effectiveness of disinfectants against Candida auris and other Candida species. Infect Control Hosp Epidemiol. 2017;38:1240–3.  https://doi.org/10.1017/ice.2017.162.CrossRefPubMedGoogle Scholar
  33. 33.
    Madder H, Moir I, Moroney R, Butcher L, Newnham R, Sunderland M, Clarke T, Foster D, Hoffman P, Moore G, Brown CS, Jeffery KJM. 2017. Multiuse patient monitoring equipment as a risk factor for acquisition of Candida auris. bioRxiv 149,054.  https://doi.org/10.1101/149054.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of TexasHoustonUSA

Personalised recommendations