Something wicked this way comes: What health care providers need to know about Candida auris

Abstract

Candida auris is a fungal pathogen that recently emerged and rapidly spread around the globe. It is now in Canada. C. auris can cause invasive disease with high mortality rates, is frequently resistant to one or more classes of antifungals, and can be difficult to identify in some clinical microbiology laboratories. C. auris can also involve prolonged colonization of patients' skin and contamination of surrounding environments, resulting in nosocomial outbreaks in hospitals and long-term care facilities. Clinicians, infection prevention and control practitioners and public health officials should be aware of how to mitigate the threat posed by this pathogen. Index cases of C. auris should be suspected in patients with invasive candidiasis and recent hospitalization in global regions where C. auris is prevalent, as well as in patients who fail to respond to empiric antifungal therapy and from whom unidentified or unusual Candida species have been isolated. If a case of C. auris infection or colonization is identified or suspected, the following should take place: notification of local public health authorities and infection prevention and control practitioners; placement of colonized or infected patients in single rooms with routine contact precautions; daily and terminal environmental disinfection with a sporicidal agent; contact tracing and screening for C. auris transmission; and referral of suspicious or confirmed isolates to provincial laboratories. Patients with symptomatic disease should be treated with an echinocandin pending the results of antifungal susceptibility testing, preferably in consultation with an infectious disease specialist. Through the vigilance of front-line health care workers and microbiologists, robust infection prevention and control practices, and local and national surveillance efforts, C. auris can be detected quickly, infections managed and transmissions prevented to protect patients in our health care system.

Clinical Issues—September 2019

“…Compared with other Candida species, C auris is less susceptible to the three major antifungal classes: fluconazole, amphotericin B, and echinocandins . The susceptibility appears to be geographically related, with fluconazole resistance being the most widespread, although not universal . Amphotericin B resistance rates are estimated to be 30% to 40%, and echinocandin resistance is approximately 5% to 10% .…”

“…Candida auris is an emerging yeast pathogen that is a global concern because it can cause invasive disease with a high mortality risk, spread easily, and be highly drug‐resistant and difficult to identify . It was discovered in a Tokyo hospital in 2009, where scientists isolated the species from external ear canal discharge from a 70‐year‐old Japanese woman .…”

“…Transmission of these traditional types of Candida infections to other patients or health care workers has been rare . Candida auris , on the other hand, can reside on the skin and spread to the environment, living on surfaces for one month or longer and providing a pathway for transmission to other patients and health care personnel …”

“…It is difficult to identify C auris using standard laboratory testing methods, such as the commercial biochemical identification systems that are found in most clinical microbiology laboratories. Additionally, C auris can be misidentified as Candida haemulonii or Candida sake , which can lead to practitioners administering the incorrect antifungal medication to patients, resulting in potential transmission to other patients and health care providers . However, there are specialized laboratory tests, such as matrix‐assisted laser desorption ionization time‐of‐flight (MALDI‐TOF) mass spectrometry instruments and molecular‐based sequencing methods, that can accurately identify C auris .…”

“…Additionally, C auris can be misidentified as Candida haemulonii or Candida sake , which can lead to practitioners administering the incorrect antifungal medication to patients, resulting in potential transmission to other patients and health care providers . However, there are specialized laboratory tests, such as matrix‐assisted laser desorption ionization time‐of‐flight (MALDI‐TOF) mass spectrometry instruments and molecular‐based sequencing methods, that can accurately identify C auris . The CDC's Antibiotic Resistance Laboratory Network, which has seven regional laboratories, also can identify C auris and perform susceptibility testing.…”