The laboratory investigation, management, and infection prevention and control of Candida auris: a narrative review to inform the 2024 national guidance update in England

Jones, Christopher R.; Neill, Claire; Borman, Andrew M.; Budd, Emma L.; Cummins, Martina; Fry, Carole; Guy, Rebecca L.; Jeffery, Katie; Johnson, Elizabeth M.; Manuel, Rohini; Mirfenderesky, Mariyam; Moore, Ginny; Patel, Bharat; Schelenz, Silke; Staniforth, Karren; Taori, Surabhi K.; Brown, Colin S.

doi:10.1099/jmm.0.001820

Cited by 3 publications

References 157 publications

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Key factors to consider forCandida aurisscreening in healthcare settings: a systematic review

Danielsen,

Ødeskaug,

Raastad

et al. 2024

Preprint

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BackgroundCandida aurisis an emerging fungal pathogen that is often multidrug-resistant. It can persist on skin and in hospital environments, leading to outbreaks and severe infections for patients at risk. Several countries and institutions are working on establishing guidelines and recommendations for prevention. This review aims to assess the evidence on factors associated withC. auriscolonisation or infection, the duration of such colonisation, possible colonisation sites, and the risk of secondary transmission to inform screening recommendations. Methods We systematically searched five databases for primary studies and systematic reviews of our four outcomes. We excluded studies on treatment, management, laboratory methods, drug resistance, and environmental screening. From each paper, we extracted relevant data and summarised them in tables. Main findings were described narratively. Results We selected 117 studies for inclusion. Most of the studies were observational studies. The duration ofC. auriscolonisation varied, with up to and beyond a year being common. The predominant sites of colonisation were the axillae and groin, with the nares and rectum being less common sites. The risk of secondary infection saw considerable variation across the studies, and these secondary cases primarily involved patients and not health care workers. Critical care settings, invasive medical devices, recent antimicrobial use, and comorbidities were often associated withC. auriscolonisation and infection. Conclusion Our review highlights that, despite relevant findings on factors influencingC. auriscolonisation and infection, substantial gaps remain in the evidence supporting screening practices. Most studies were conducted reactively, in outbreak settings, and lack systematic protocols. Given these limitations, screening guidelines are likely to be more successful if grounded in medical theory and yeast microbiology rather than relying solely on current studies. Rigorous, well-designed research is urgently needed to inform futureC. aurisscreening and control efforts.

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Key factors to consider forCandida aurisscreening in healthcare settings: a systematic review

Danielsen,

Ødeskaug,

Raastad

et al. 2024

Preprint

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Enhancing ICU Candida spp. surveillance: a cost-effective approach focused on Candida auris detection

Nascimento,

Inácio,

Guerreiro

et al. 2024

Front. Cell. Infect. Microbiol.

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IntroductionCandida auris is an emerging pathogen that represents a worldwide health problem due to its global expansion, multidrug resistance, and difficult laboratory identification. Among the risk factors for colonization/infection by C. auris, a stay in an intensive care unit (ICU) stands out. This prospective multicenter study aimed to monitor the trend of the local epidemiology of Candida spp. and unveil the prevalence of C. auris.MethodsFrom 2020 to 2022, axillar/inguinal swabs were collected from adult patients at three points: upon admission (D1) and on the fifth (D5) and eighth (D8) days of their ICU stay. We employed culture-based screening methods combined with molecular techniques to identify Candida spp. down to the species level. Specific screening for Candida auris was conducted using a real-time PCR assay in combination with an improved selective culture medium, mannitol salt agar auris (MSAA). To validate the effectiveness of MSAA, a collection of reference C. auris strains representing the four major geographical clades was used.ResultsWe enrolled 675 patients, and 355 Candida isolates were retrieved from the 988 swab samples collected. From those, 185/355 (52.1%) were identified as C. albicans and 170/355 (47.9%) as non-albicans Candida (NAC). MSAA medium showed a specificity of 94.8%, albeit C. auris was not detected in this cohort. The dynamics of Candida spp. colonization by ICU were significant at the three collection points. Upon admission, C. albicans was associated with the Beatriz Ângelo Hospital ICU (p=0.003) and C. tropicalis with the general Hospital Professor Doutor Fernando Fonseca (FFH) ICU (p=0.006). C. parapsilosis and C. lusitaniae were associated with FFH ICUs, with the general ICU at D5 (p=0.047) and surgical ICU at D8 (p=0.012). The dynamics of NAC colonization by ICU were significantly different at D1 (p=0.011), D5 (p=0.047), and D8 (p=0.012).ConclusionWe developed and implemented a screening protocol for C. auris while uncovering the colonization patterns of Candida in the ICU. Our findings contribute to the optimization of overall patient management, ensuring that ICU protocols are resilient and adaptive to emerging fungal threats.

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Cerebrospinal Drain Infection by Candida auris: A Case Report and Review of the Literature

Halioti,

Vrettou,

Neromyliotis

et al. 2024

JoF

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Candida auris is notorious for its ability to spread within healthcare environments, particularly in intensive care units (ICUs), posing significant challenges for clinicians as treatment options become limited. This is especially concerning in the context of central nervous system (CNS)-invasive infections. While rare, its involvement in nosocomial brain ventriculitis presents substantial diagnostic and therapeutic challenges, with no established guidelines for managing CNS infections caused by Candida auris. This report presents a case of Candida auris ventriculitis in an ICU patient and offers a comprehensive and targeted literature review, emphasizing diagnostic approaches, treatment strategies, and the clinical complexities of managing this emerging pathogen in CNS infections.

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The laboratory investigation, management, and infection prevention and control of Candida auris: a narrative review to inform the 2024 national guidance update in England

Cited by 3 publications

References 157 publications

Key factors to consider forCandida aurisscreening in healthcare settings: a systematic review

Key factors to consider forCandida aurisscreening in healthcare settings: a systematic review

Enhancing ICU Candida spp. surveillance: a cost-effective approach focused on Candida auris detection

Cerebrospinal Drain Infection by Candida auris: A Case Report and Review of the Literature

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