Candida auris outbreak: Mortality, interventions and cost of sustaining control

Taori, Surabhi; Khonyongwa, Kirstin; Hayden, Iain; Athukorala, Gid Dushyanthie Ad; Letters, Andrew; Fife, Amanda; Desai, Nergish; Borman, Andrew M.

doi:10.1016/j.jinf.2019.09.007

Cited by 59 publications

(52 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…To date, catheter-associated infections caused by C. auris have been reported by several authors, which are attributable to the previously well-documented biofilm-forming ability of this species (Dewaele et al, 2018). Previous studies reported the frequency of central line infections by C. auris to be between 11 and 92% (Lee et al, 2011;Schelenz et al, 2016;Taori et al, 2019). Although sessile communities show significantly higher resistance to the majority of frequently used antifungals compared to planktonic susceptibilities (Kean and Ramage, 2019), the efficacy of such antifungal agents can be enhanced using adjuvants such as farnesol (Nagy et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

In vitro and in vivo Effect of Exogenous Farnesol Exposure Against Candida auris

et al. 2020

Self Cite

View full text Add to dashboard Cite

The spreading of multidrug-resistant Candida auris is considered as an emerging global health threat. The number of effective therapeutic regimens is strongly limited; therefore, development of novel strategies is needed. Farnesol is a quorum-sensing molecule with a potential antifungal and/or adjuvant effect; it may be a promising candidate in alternative treatment against Candida species including C. auris. To examine the effect of farnesol on C. auris, we performed experiments focusing on growth, biofilm production ability, production of enzymes related to oxidative stress, triazole susceptibility and virulence. Concentrations ranging from 100 to 300 µM farnesol caused a significant growth inhibition against C. auris planktonic cells for 24 h (p < 0.01-0.05). Farnesol treatment showed a concentration dependent inhibition in terms of biofilm forming ability of C. auris; however, it did not inhibit significantly the biofilm development at 24 h. Nevertheless, the metabolic activity of adhered farnesol pre-exposed cells (75 µM) was significantly diminished at 24 h depending on farnesol treatment during biofilm formation (p < 0.001-0.05). Moreover, 300 µM farnesol exerted a marked decrease in metabolic activity against one-day-old biofilms between 2 and 24 h (p < 0.001). Farnesol increased the production of reactive species remarkably, as revealed by 2 ,7-dichlorofluorescein (DCF) assay {3.96 ± 0.89 [nmol DCF (OD 640) −1 ] and 23.54 ± 4.51 [nmol DCF (OD 640) −1 ] for untreated cells and farnesol exposed cells, respectively; p < 0.001}. This was in line with increased superoxide dismutase level {85.69 ± 5.42 [munit (mg protein) −1 ] and 170.11 ± 17.37 [munit (mg protein) −1 ] for untreated cells and farnesol exposed cells, respectively; p < 0.001}, but the catalase level remained statistically comparable between treated and untreated cells (p > 0.05). Concerning virulence-related enzymes, exposure to 75 µM farnesol did not influence phospholipase or aspartic proteinase activity (p > 0.05). The interaction between fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole and farnesol showed clear synergism (FICI ranges from 0.038 to 0.375) against one-day-old biofilms. Regarding in vivo experiments, daily 75 µM farnesol treatment decreased the

show abstract

Section: Discussionmentioning

confidence: 99%

In vitro and in vivo Effect of Exogenous Farnesol Exposure Against Candida auris

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…The preferential colonization of certain superficial body sites (axilla, groin) but not the intestinal tract fits well with the thermo-and halotolerance of the organism and its inability to prosper in anaerobic or acidic conditions [18] but again, is in contrast to most Candida infections that are acquired in hospital, which result from a patient's own microbiome, often in the gastrointestinal tract. In addition, the finding that heavily colonized patients shed large quantities of C. auris (presumably via skin squames) into the environment and that the degree of shedding can be directly tied to the onward attack rate (i.e., the likelihood of that patient resulting in the colonization/ infection of others on the same hospital unit) certainly sets C. auris aside from most other yeast species encountered in the clinical arena [13].…”

Section: How Unusual Is C Auris?mentioning

confidence: 99%

“…However, the clonal lineages in C. glabrata have been extensively re-distributed worldwide and become intermingled, presumably as a result of global changes in travel and trade [20]. The same is rapidly becoming true with C. auris, with isolates from the 4 known clonal lineages being introduced into countries worldwide [6][7][8][9][10][11][12][13]. Thus, perhaps what is actually most novel with C. auris is that improved identification and strain-typing methodologies have allowed mycologists to track the global spread of C. auris in real time as it emerged as a human pathogen on the various continents.…”

Section: How Unusual Is C Auris?mentioning

confidence: 99%

See 1 more Smart Citation

Candida auris in the UK: Introduction, dissemination, and control

Borman

Johnson

2020

PLoS Pathog

Self Cite

View full text Add to dashboard Cite

Candida auris is an emerging yeast that has been reported as a cause of human infections in over 30 countries and 6 continents since its first description 10 years ago [1-12]. Capable of causing large nosocomial outbreaks, usually in high-dependency units [3-12], C. auris has the ability to colonize patients almost indefinitely and to contaminate hospital environments and medical equipment [6, 8]. Whole-genome sequence (WGS) analyses have revealed the existence of at least 4 phylogenetically separate clonal lineages of C. auris, each with firm associations with distinct geographic regions: clade I (Southern Asia), clade II (East Asia), clade III (South Africa), and clade IV (South America) [9]. WGS has revealed minimal diversity between isolates within each clade but vast sequence divergence between different clades, consistent with their almost simultaneous and very recent emergence as human colonizers/pathogens in multiple geographic areas [9]. Subsequent outbreaks reported in the United Kingdom, Central and Southern Europe, and North America have all been seeded by isolates that can be mapped genetically to 1 of these 4 clonal lineages [6-8, 10-13]. Interestingly, a potential fifth clade was recently described from a case of otitis in Iran [14], although to date, this has not been responsible for any nosocomial outbreaks. The introduction of C. auris into the UK and subsequent nearnationwide spread Irrespective of whether the 4 major clonal lineages identified to date originated in South Asia, South Africa, South America, and East Asia or were transported there from elsewhere and found conditions favorable to their amplification, it is clear that all outbreaks and individual cases of C. auris infection worldwide can be traced back to isolates from those lineages [6-8, 10-13]. A retrospective analysis of historical isolates of unusual Candida species performed at the Public Health England (PHE) UK National Mycology Reference Laboratory (MRL) failed to find any evidence of C. auris in the UK prior to 2013. In 2013, the MRL received the first 3 isolates of C. auris, which originated from blood cultures from unrelated patients in 3 geographically separated healthcare centers [12]. A further isolate was referred to our laboratory in 2014, with 15 additional isolates (9 from sterile/deep sites) in 2015. By mid-2019, PHE had recorded approximately 270 cases of C. auris in England, including at least 35 cases of candidemia [15]. The majority of noninvasive cases involved patients colonized with C. auris, which were detected during enhanced screening of patients at 3 large hospitals in Southern England that experienced protracted outbreaks [6,10,13]. Genetic analyses have confirmed that 3 of the 4 clonal lineages (South Asia, South Africa, and East Asia) have been introduced multiple times into the UK [12] (Fig 1), with the widespread outbreaks fueled by isolates of the South Asian and South African lineages [6,10,13], and isolates from 2 different clades reported

show abstract

“…C. auris infection is often associated with underlying illnesses and outbreaks have been reported in intensive care units in multiple countries [11][12][13]. C. auris infection is also associated with previous exposure to antibiotics or antifungals [14,15]. Immunocompromised patient populations such as those in haematology/oncology wards or solid organ transplant wards often receive prophylactic antifungals [16,17]; additionally, antifungal use was reported to be higher in ICUs compared to non-ICU wards [18].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Candida auris in Canadian acute care hospitals among at-risk patients, 2018

Garcia-Jeldes

Mitchell

McGeer

et al. 2020

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

To identify the prevalence of C. auris in Canadian patients who are potentially at risk for colonization, we screened 488 patients who were either hospitalized abroad, had a carbapenemase-producing organism (CPO), or were in units with high antifungal use. Two patients were colonized with C. auris; both had received healthcare in India and had a CPO. Among 35 patients who had recently received healthcare in the Indian subcontinent and were CPO colonized or infected, the prevalence of C. auris was 5.7%.

show abstract

Candida auris outbreak: Mortality, interventions and cost of sustaining control

Cited by 59 publications

References 21 publications

In vitro and in vivo Effect of Exogenous Farnesol Exposure Against Candida auris

In vitro and in vivo Effect of Exogenous Farnesol Exposure Against Candida auris

Candida auris in the UK: Introduction, dissemination, and control

Prevalence of Candida auris in Canadian acute care hospitals among at-risk patients, 2018

Contact Info

Product

Resources

About