Is the superbug fungus really so scary? A systematic review and meta-analysis of global epidemiology and mortality of Candida auris

Abstract

Background Candida auris is a new pathogen called “superbug fungus” which caused panic worldwide. There are no large-scale epidemiology studies by now, therefore a systematic review and meta-analysis was undertaken to determine the epidemic situation, drug resistance patterns and mortality of C. auris. Methods We systematically searched studies on the clinical report of Candida auris in Pubmed, Embase and Cochrane databases until October 6, 2019. A standardized form was used for data collection, and then statics was performed with STATA11.0. Results It showed that more than 4733 cases of C. auris were reported in over 33 countries, with more cases in South Africa, United States of America, India, Spain, United Kingdom, South Korea, Colombia and Pakistan. C. auirs exhibited a decrease in case count after 2016. Clade I and III were the most prevalent clades with more cases reported and wider geographical distribution. Blood stream infection was observed in 32% of the cases, which varied depending on the clades. Resistance to fluconazole, amphotericin B, caspofungin, micafungin and anidulafungin in C. auris were 91, 12, 12.1, 0.8 and 1.1%. The overall mortality of C. auris infection was 39%. Furthermore, subgroup analyses showed that mortality was higher in bloodstream infections (45%), and lower in Europe (20%). Conclusions Over 4000 cases of C. auris were reported in at least 33 countries, which showed high resistance to fluconazole, moderate resistance to amphotericin B and caspofungin, high sensitivity to micafungin and anidulafungin. The crude mortality for BSI of C. auris was 45% which was similar to some drug-resistant bacteria previously reported. In conclusion, C. auris displayed similar characteristics to some drug resistance organisms. This study depicts several issues of C. auris that are most concerned, and is of great significance for the clinical management.

Transcriptome Signatures Predict Phenotypic Variations of Candida auris

“…While the majority of identified C. auris isolates display intrinsic resistance to azoles such as fluconazole, susceptibilities to other antifungals strongly vary among clades. Recent studies demonstrated that clade II isolates (East Asian clade) show the highest degree of antifungal susceptibilities, while clade I strains (South Asian clade) show the lowest susceptibility (Arendrup et al, 2017;Szekely et al, 2019;Chen et al, 2020;Chow et al, 2020). In line with this, resistance to the polyene amphotericin B (AmB) was mainly detected in clade I and clade IV (South America clade) isolates (Chow et al, 2020).…”

Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal Susceptibility, and Infection Control Measures to Combat the Spread of Infections in Healthcare Facilities

“…As of 15 February 2021, 47 countries have reported a single case or cluster of cases or outbreaks of C. auris infections, according to the Center for Disease Control and Prevention (CDC) of the United States of America ( accessed on 31 March 2021). The epidemiology of invasive C. auris infections has seen dramatic changes, as the sporadic invasive infections from the early years have now been replaced by nosocomial outbreaks that are being reported more frequently and appear to involve an increasing number of patients [ 29 , 30 , 31 , 32 , 37 , 38 , 39 ]. Studies have shown that once C. auris is introduced into a healthcare facility, it spreads rapidly among susceptible patients [ 40 , 41 ].…”

“…C. auris has several unique characteristics, which include its ability to persist, despite the use of common disinfectants, and remain viable for several months, likely due to biofilm formation on plastic surfaces, the hospital environment, and medical devices [ 68 , 69 , 70 ]. Furthermore, very high rates of resistance to fluconazole and variable susceptibility to other azoles, amphotericin B, and echinocandins make the management of C. auris infections extremely difficult [ 37 , 56 , 57 , 58 , 71 , 72 , 73 ]. Crude mortality rates varying from 0 to 72% have been reported among C. auris -infected patients in different studies [ 29 , 30 , 31 , 32 , 37 , 48 , 52 , 56 , 57 , 58 , 74 ].…”

“…Furthermore, very high rates of resistance to fluconazole and variable susceptibility to other azoles, amphotericin B, and echinocandins make the management of C. auris infections extremely difficult [ 37 , 56 , 57 , 58 , 71 , 72 , 73 ]. Crude mortality rates varying from 0 to 72% have been reported among C. auris -infected patients in different studies [ 29 , 30 , 31 , 32 , 37 , 48 , 52 , 56 , 57 , 58 , 74 ]. C. auris frequently colonizes the axilla, groin, nares, respiratory tract, and urinary tract in hospitalized patients [ 29 , 30 , 31 , 32 , 58 , 75 , 76 , 77 , 78 ].…”

“…An important reason for C. auris to be known as a “superbug” in recent years is its intrinsic resistance to one, more and sometimes to all available antifungal drugs [ 30 , 37 , 62 , 73 ]. Generally, C. auris strains exhibit very high rates of resistance to fluconazole and a variable susceptibility to other azoles, amphotericin B, and echinocandins, which makes the antifungal management of C. auris infections, particularly invasive infections in patients with multiple comorbidities, extremely difficult [ 29 , 30 , 31 , 32 , 39 , 58 , 62 ].…”