On the emergence, spread and resistance of Candida auris: host, pathogen and environmental tipping points

Abstract

Over a decade ago, a multidrug-resistant nosocomial fungus Candida auris emerged worldwide and has since become a significant challenge for clinicians and microbiologists across the globe. A resilient pathogen, C. auris survives harsh disinfectants, desiccation and high-saline environments. It readily colonizes the inanimate environment, susceptible patients and causes invasive infections that exact a high toll. Prone to misidentification by conventional microbiology techniques, C. auris rapidly acquires multiple genetic determinants that confer multidrug resistance. Whole-genome sequencing has identified four distinct clades of C. auris, and possibly a fifth one, in circulation. Even as our understanding of this formidable pathogen grows, the nearly simultaneous emergence of its distinct clades in different parts of the world, followed by their rapid global spread, remains largely unexplained. We contend that certain host–pathogen–environmental factors have been evolving along adverse trajectories for the last few decades, especially in regions where C. auris originally appeared, until these factors possibly reached a tipping point to compel the evolution, emergence and spread of C. auris. Comparative genomics has helped identify several resistance mechanisms in C. auris that are analogous to those seen in other Candida species, but they fail to fully explain how high-level resistance rapidly develops in this yeast. A better understanding of these unresolved aspects is essential not only for the effective management of C. auris patients, hospital outbreaks and its global spread but also for forecasting and tackling novel resistant pathogens that might emerge in the future. In this review, we discuss the emergence, spread and resistance of C. auris, and propose future investigations to tackle this resilient pathogen.

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“…и Пакистане (штамм 2008 г.) [3,4]. Эти данные свидетельствуют о существовании вида C. auris до 2009 г. Однако незна чительное количество выявленных при пересмотре кол лекций клинических штаммов C. auris говорит о крайне низкой частоте вызываемых им инфекций в тот период.…”

“…Полногеномное секвенирование C. auris, выделен ных в различных странах, выявило 4 основные попу ляции, в которых изоляты кластеризуются в зависимо сти от предполагаемого региона происхождения [3,4]. КМАХ .…”

Candida auris: A Quick Review on Identification, Current Treatments, and Challenges

“…The most worrisome aspects associated with infection caused by C. auris can be summarized in three levels: High rate of antifungal drug resistance [ 9 ], mode and pace of its easy transmission among healthcare workers and patients in hospitals, and misidentification. This last level is related to difficulties in a correct identification of C. auris strains, which are commonly misidentified as other phylogenetically-related pathogens, but also due to inadequacies of common diagnostic tools to precise identification of C. auris in many countries that result in misidentification and incorrect therapy, which lead to the acquisition of multiple genetic determinants that confer multidrug resistance [ 11 , 12 , 13 , 14 ].…”

“…In addition, it rapidly colonizes abiotic surfaces, immunosuppressed individuals, and causes invasive infections that exact a high toll [ 7 , 14 , 15 , 16 , 17 , 18 , 19 ]. Studies have demonstrated that the Hog1-related stress-activated protein kinase (SAPK) signaling pathway has a central role in the C. auris reaction to osmotic stress, and it is a crucial virulence factor in several human fungi [ 1 , 2 ].…”

Setting a Protocol for Identification and Detecting the Prevalence of Candida auris in Tertiary Egyptian Hospitals Using the CDC Steps

“…However, even as knowledge about C. auris grows, notable gaps remain in the understanding of Candida auris emergence, spread, and resistance [9]. Especially from countries such as Qatar, Jordan, and Egypt [10].…”