The battle against fungi: lessons in antifungal stewardship from COVID 19 times

Kanj, Souha S.; Haddad, Samuel; Meis, Jacques F.; Verweij, Paul E.; Voß, Andreas; Rautemaa‐Richardson, Riina; Levy-Hara, Gabriel; Chowdhary, Anuradha; Ghafur, Abdul; Brüggemann, Roger J. M.; Bal, Abhijit M.; Schouten, Jeroen

doi:10.1016/j.ijantimicag.2023.106846

Cited by 9 publications

(3 citation statements)

References 120 publications

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“…In a systematic review of 17 studies reporting multidrug-resistant (MDR) outbreaks in ICUs, mainly caused by C. auris (n = 6), during the COVID-19 pandemic, the most commonly identified factors contributing to the outbreaks were inadequate PPE or a shortage of PPE, hand hygiene non-adherence, and high antibiotic use, followed by environmental contamination, prolonged critical illness and lack of trained HCWs [101]. Therefore, all HCWs attending C. auris-infected or -colonized patients should apply standard hand hygiene practices and perform adequate hand hygiene with soap and water, alcohol-based hand sanitizers, or chlorhexidine hand rubs [6,10,20,22,90,[102][103][104].…”

Section: Transmission-based Precautionsmentioning

confidence: 99%

The Gordian Knot of C. auris: If You Cannot Cut It, Prevent It

Rapti,

Iliopoulou,

Poulakou

2023

Pathogens

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Since its first description in 2009, Candida auris has, so far, resulted in large hospital outbreaks worldwide and is considered an emerging global public health threat. Exceptionally for yeast, it is gifted with a profoundly worrying invasive potential and high inter-patient transmissibility. At the same time, it is capable of colonizing and persisting in both patients and hospital settings for prolonged periods of time, thus creating a vicious cycle of acquisition, spreading, and infection. It exhibits various virulence qualities and thermotolerance, osmotolerance, filamentation, biofilm formation and hydrolytic enzyme production, which are mainly implicated in its pathogenesis. Owing to its unfavorable profile of resistance to diverse antifungal agents and the lack of effective treatment options, the implementation of robust infection prevention and control (IPC) practices is crucial for controlling and minimizing intra-hospital transmission of C. auris. Rapid and accurate microbiological identification, adherence to hand hygiene, use of adequate personal protective equipment (PPE), proper handling of catheters and implantable devices, contact isolation, periodical environmental decontamination, targeted screening, implementation of antimicrobial stewardship (AMS) programs and communication between healthcare facilities about residents’ C. auris colonization status are recognized as coherent strategies for preventing its spread. Current knowledge on C. auris epidemiology, clinical characteristics, and its mechanisms of pathogenicity are summarized in the present review and a comprehensive overview of IPC practices ensuring yeast prevention is also provided.

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Section: Transmission-based Precautionsmentioning

confidence: 99%

The Gordian Knot of C. auris: If You Cannot Cut It, Prevent It

Rapti,

Iliopoulou,

Poulakou

2023

Pathogens

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“…auris has quickly developed into a global concern and cemented its place as a superbug within just a decade after its first isolation in 2009 (9). Since its emergence, it has been identified in hospitals across five continents, particularly increasing in incidence during the COVID-19 pandemic (4,15,16). The role played by the coronavirus disease (COVID- 19) pandemic in this increase is difficult to ascertain, while restricted travel may have decreased the risk of importation of C. auris, difficult-to-control outbreaks of C. auris have continued to be reported in units caring for COVID-19 patients worldwide (17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Emergence of highly resistant Candida auris in the United Arab Emirates: a retrospective analysis of evolving national trends

Thomsen,

Abdulrazzaq,

Oulhaj

et al. 2024

Front. Public Health

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IntroductionThe Centers for Disease Prevention and Control lists Candida auris, given its global emergence, multidrug resistance, high mortality, and persistent transmissions in health care settings as one of five urgent threats. As a new threat, the need for surveillance of C. auris is critical. This is particularly important for a cosmopolitan setting and global hub such as the United Arab Emirates (UAE) where continued introduction and emergence of resistant variant strains is a major concern.MethodsThe United Arab Emirates has carried out a 12 years of antimicrobial resistance surveillance (2010–2021) across the country, spanning all seven Emirates. A retrospective analysis of C. auris emergence from 2018–2021 was undertaken, utilising the demographic and microbiological data collected via a unified WHONET platform for AMR surveillance.ResultsNine hundred eight non-duplicate C. auris isolates were reported from 2018–2021. An exponential upward trend of cases was found. Most isolates were isolated from urine, blood, skin and soft tissue, and the respiratory tract. UAE nationals nationals comprised 29% (n = 186 of 632) of all patients; the remainder were from 34 other nations. Almost all isolates were from inpatient settings (89.0%, n = 809). The cases show widespread distribution across all reporting sites in the country. C. auris resistance levels remained consistently high across all classes of antifungals used. C. auris in this population remains highly resistant to azoles (fluconazole, 72.6% in 2021) and amphotericin. Echinocandin resistance has now emerged and is increasing annually. There was no statistically significant difference in mortality between Candida auris and Candida spp. (non-auris) patients (p-value: 0.8179), however Candida auris patients had a higher intensive care unit (ICU) admission rate (p-value <0.0001) and longer hospital stay (p < 0.0001) compared to Candida spp. (non-auris) patients.ConclusionThe increasing trend of C. auris detection and associated multidrug resistant phenotypes in the UAE is alarming. Continued C. auris circulation in hospitals requires enhanced infection control measures to prevent continued dissemination.

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“…The list clearly points out that improving public health interventions, regulating clinical diagnosis and treatment, increasing the monitoring of global fungal infections and pathogen resistance, and enhancing the development of diagnostic methods and therapeutic drugs are important strategies for IFD management. In addition, in the context of the novel coronavirus disease 2019 (COVID-19) pandemic, the incidence of COVID-19-associated invasive mycoses is about 12.6% and fungal diseases have become important complications, which further demonstrates the complexity and urgency of antifungal drug management ( 9 - 13 ). Currently, many countries have explored AFS programs and established relevant guidelines to improve the clinical management, diagnosis and treatment of IFD, confirming that the use and promotion of AFS may improve the clinical treatment to a certain extent ( 14 , 15 ).…”

Section: Introductionmentioning

confidence: 99%

Consensus for antifungal stewardship in China (2024 edition)

Ye,

Cai,

Cao

et al. 2024

J Thorac Dis

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The battle against fungi: lessons in antifungal stewardship from COVID 19 times

Cited by 9 publications

References 120 publications

The Gordian Knot of C. auris: If You Cannot Cut It, Prevent It

The Gordian Knot of C. auris: If You Cannot Cut It, Prevent It

Emergence of highly resistant Candida auris in the United Arab Emirates: a retrospective analysis of evolving national trends

Consensus for antifungal stewardship in China (2024 edition)

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