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

Abstract

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.

Pathogenesis, Prophylaxis, and Treatment of Candida auris

“…A significant increase in new instances of colonization and infection has been detected as a result of the coronavirus disease 2019 (COVID-19) pandemic, which has altered the landscape of C. auris illness [ 2 , 17 ]. This increase is mostly attributable to the overburden of global healthcare systems and the resulting weakening of infection prevention and control procedures [ 2 , 18 ].…”

“…It is possible that the prevalence and geographic scope of C. auris illness, which primarily affects low- and middle-income nations, are underestimated [ 2 ]. The lack of a worldwide identification plan and the low precision of the current generation of traditional diagnostic instruments are the two main causes of data scarcity [ 2 ].…”

“…The cells are 2.5–5.0 μm in size, ovoid, and ellipsoidal to elongate [ 7 ]. Rarely, it can undergo filamentation, a crucial stage in the fungal invasion of host tissues, in the same way as other Candida species, producing both pseudohyphae and real hyphae [ 2 ]. C. auris can create basic pseudohyphae in biofilm development and under high-salinity conditions [ 26 ].…”

“…Candida auris is an increasingly dangerous fungus that poses a threat to world health [ 1 ]. Deep-seated infections and devious hospital outbreaks may be caused by C. auris [ 2 ]. It is mostly collected from hospital surroundings, and because of its special characteristics, it can colonize and remain for extended periods in both patients and hospital settings, which can lead to a vicious cycle of infection, acquisition, and spread, especially in intensive care units [ 2 ].…”

“…Deep-seated infections and devious hospital outbreaks may be caused by C. auris [ 2 ]. It is mostly collected from hospital surroundings, and because of its special characteristics, it can colonize and remain for extended periods in both patients and hospital settings, which can lead to a vicious cycle of infection, acquisition, and spread, especially in intensive care units [ 2 ]. It meets all the requirements to be categorized as an urgent public health threat, including the capacity to spread quickly through horizontal transmission, the potential to infect susceptible people with serious and potentially fatal infections, and the unfavorable profile of antifungal agent resistance, in addition to the dearth of standardized preventive and control measures and effective treatment options [ 3 , 4 ].…”