Federation of Infectious Diseases Societies of Southern Africa guideline: Recommendations for the detection, management and prevention of healthcare-associated Candida auris colonisation and disease in South Africa

Abstract

The reasons for the dramatic emergence of C. auris as a pathogen in healthcare settings are not clear. We know that East Asia, South Asia, Africa and South America have unique C. auris clades separated from other clades by tens of thousands of single nucleotide polymorphisms. 10 This is consistent with the hypothesis that C. auris emerged independently and simultaneously on several continents. While C. auris is likely to have an environmental reservoir outside the healthcare setting, this has yet to be established. Several intrinsic properties of the pathogen probably facilitated its rapid spread in hospitals. C. auris produces biofilms. 11,12,13 While this fungus Candida auris has been detected at almost 100 South African hospitals, causing large outbreaks in some facilities, and this pathogen now accounts for approximately 1 in 10 cases of candidaemia. The objective of this guideline is to provide updated, evidence-informed recommendations outlining a best-practice approach to prevent, diagnose and manage C. auris disease in public-and private-sector healthcare settings in South Africa. The 18 practical recommendations cover five focus areas: laboratory identification and antifungal susceptibility testing, surveillance and outbreak response, infection prevention and control, clinical management and antifungal stewardship.

Clade distribution of Candida auris in South Africa using whole genome sequencing of clinical and environmental isolates

“…This distribution was also observed in a larger national study of candidaemia during 2016–2017 [ 7 ]. Indiscriminate use of azoles and echinocandins, and inadequate infection prevention and control measures may have led to the emergence and subsequent establishment of C. auris in acute-care hospitals in this province [ 7 , 20 , 21 ]. Clade III was the dominant clade in our study.…”

Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–20171

“…Fluconazole is commonly used as a first-line treatment option, especially in public-sector hospitals, where access to echinocandin antifungal drugs is currently limited. The forthcoming 2019 guidelines for treatment of C. auris in South Africa recommend echinocandins as a first-line treatment for candidemia and amphotericin B deoxycholate if echinocandins are unavailable (22). In contrast to other Candida species, such as C. parapsilosis, for which a substantial proportion of infections occur among the neonatal population, C. auris occurs among older adults (12).…”

Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center

“…The prominent biofilm formation capacity on medical devices is thought to allow this species to not only become one of the most prevalent Candida species in clinical settings, but also the reason behind severe clonal outbreaks [ 19 ]. Biofilm production allowed C. parapsilosis to avidly adhere to plastic surfaces and survive for several weeks [ 20 ], which may have also rendered this species less susceptible to some chlorine-based disinfectants when compared to other Candida species [ 21 ]. Although it is hypothesized that invasive infections due to C. parapsilosis are mostly owing to horizontal transfer from contaminated environments [ 22 ], nonetheless, the environmental niche of ARCP isolates using the application of resolutive typing tools has yet to be determined.…”