1 May 2024 | Silvia De Gaetano, Angelina Midiri, Giuseppe Mancuso, Maria Giovanna Avola and Carmelo Biondo
Candida auris is a multidrug-resistant fungal pathogen classified as a critical priority by the World Health Organization (WHO). It causes invasive infections, including bloodstream infections, meningitis, and endocarditis, with mortality rates ranging from 30% to 72%. C. auris is easily transmitted in healthcare settings, surviving on surfaces and medical devices for extended periods. It is resistant to many antifungal drugs, with resistance patterns varying by clade and geographic region. The yeast can colonize patients and spread to others, leading to hospital outbreaks. Current diagnostic methods are challenging, and early detection is crucial for effective control. C. auris is often found in the bloodstream and has been linked to wound, catheter tip, and intra-abdominal infections. It is also isolated from ear and respiratory samples, urine, bile, and jejunal biopsies. The global distribution of C. auris includes six distinct clades, with clade I being the most prevalent. C. auris has been detected in over 100 hospitals in South Africa, causing large outbreaks and accounting for approximately 10% of candidemia cases. In India, C. auris is implicated in 5% of candidemia cases in 27 intensive care units. The diagnosis of C. auris is challenging due to the lack of specific symptoms, and it is recommended to include C. auris in the list of reportable pathogens. The prevalence of C. auris in the community is currently unknown, and there is no routine screening for this fungal pathogen upon admission to hospital. Studies in the UK and the USA found low rates of carriage upon admission, which were only identified in those who had previous exposure to a hospitalised environment. C. auris infections are severe, particularly in immunocompromised patients, and are associated with high mortality rates. The fungus is resistant to multiple antifungal agents, and pan-resistant strains have been reported. The emergence of C. auris is linked to climate change and human activity, and it has been found in various marine habitats, including public swimming pools. The global spread of C. auris is attributed to factors such as human migration and the role of birds in its transmission. C. auris is an opportunistic pathogen that can persist on human skin and abiotic surfaces, leading to significant outbreaks in healthcare facilities. The identification of C. auris is challenging, and molecular methods such as MALDI-TOF mass spectrometry and DNA-based methods are recommended. Antifungal resistance in C. auris is acquired through various mechanisms, including drug target alteration, increased efflux pump activity, and activation of cellular stress response pathways. The treatment of C. auris infections is challenging due to the absence of established susceptibility breakpoints, and echinocandins are recommended as first-line therapy. However, pan-resistant strains are a significant concern. Prevention and control measuresCandida auris is a multidrug-resistant fungal pathogen classified as a critical priority by the World Health Organization (WHO). It causes invasive infections, including bloodstream infections, meningitis, and endocarditis, with mortality rates ranging from 30% to 72%. C. auris is easily transmitted in healthcare settings, surviving on surfaces and medical devices for extended periods. It is resistant to many antifungal drugs, with resistance patterns varying by clade and geographic region. The yeast can colonize patients and spread to others, leading to hospital outbreaks. Current diagnostic methods are challenging, and early detection is crucial for effective control. C. auris is often found in the bloodstream and has been linked to wound, catheter tip, and intra-abdominal infections. It is also isolated from ear and respiratory samples, urine, bile, and jejunal biopsies. The global distribution of C. auris includes six distinct clades, with clade I being the most prevalent. C. auris has been detected in over 100 hospitals in South Africa, causing large outbreaks and accounting for approximately 10% of candidemia cases. In India, C. auris is implicated in 5% of candidemia cases in 27 intensive care units. The diagnosis of C. auris is challenging due to the lack of specific symptoms, and it is recommended to include C. auris in the list of reportable pathogens. The prevalence of C. auris in the community is currently unknown, and there is no routine screening for this fungal pathogen upon admission to hospital. Studies in the UK and the USA found low rates of carriage upon admission, which were only identified in those who had previous exposure to a hospitalised environment. C. auris infections are severe, particularly in immunocompromised patients, and are associated with high mortality rates. The fungus is resistant to multiple antifungal agents, and pan-resistant strains have been reported. The emergence of C. auris is linked to climate change and human activity, and it has been found in various marine habitats, including public swimming pools. The global spread of C. auris is attributed to factors such as human migration and the role of birds in its transmission. C. auris is an opportunistic pathogen that can persist on human skin and abiotic surfaces, leading to significant outbreaks in healthcare facilities. The identification of C. auris is challenging, and molecular methods such as MALDI-TOF mass spectrometry and DNA-based methods are recommended. Antifungal resistance in C. auris is acquired through various mechanisms, including drug target alteration, increased efflux pump activity, and activation of cellular stress response pathways. The treatment of C. auris infections is challenging due to the absence of established susceptibility breakpoints, and echinocandins are recommended as first-line therapy. However, pan-resistant strains are a significant concern. Prevention and control measures