Candida auris- Recent Emergence of multidrug resistance fungal infection.

Candida is a common yeast or fungi frequently present on many parts of humans including the skin, the gastrointestinal tract, and the urinary and genital organs. Candida auris is a species of Candida which was first described as human pathogen only in 2009 ¹. Since 2009, Candida auris infections have been described in over 20 countries in 5 continents. Candida auris can be spread either patient to patient or by autoinfection from the patient’s own flora. Infection control measures like regular handwashing, cleaning of patients’ rooms, and patient hygiene is critical for controlling Candida auris hospital infections.

Many Candida auris strains are resistant to most common anti-fungal drugs including azoles, amphotericin B, and the echinocandins ²   Candida auris infections are often fatal. A study of 54 patients with Candida infections reported that 61% had bloodstream infections and 59% died ². Looking at microbiological isolates from these patients, 93% were resistant to fluconazole (an azole), 35% were resistant to amphotericin B, and 7% were resistant to echinocandins, 41% were resistant to 2 antifungal classes, and 4% were resistant to all 3 classes of anti-fungals.²

Candida is often not identified to species levels in hospital labs. Since many Candida species have characteristic and different antifungal drug resistance patterns, identifying Candida infections to species level can be useful for patient treatment. Molecular methods or matrix-assisted laser desorption ionization-time of flight mass spectroscopy can assist with the identification of Candida species.

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The mechanisms of Candida auris anti-fungal drug resistance are not well known- but may be due to mutations of the Erg11, KFS, and ergosterol mutations or by efflux pump activity. While many Candida species are successfully treated with azoles such as fluconazole,- about 90% of Candida auris species are resistant to fluconazole ². The recommended first-line treatment for most Candida auris species are the echinocandin drugs such as caspofungin, micafungin, and anidulafungin.

Risk factors for Candida auris infections are similar to other Candida infections including cancer, diabetes, surgery, history of antifungal drug treatment, hospitalization, use of ventilators, and respiratory infections. Close healthcare facility exposure to patients with Candida auris infections also increases the risk of infection. Candida auris can remain viable for at least 4 weeks on dry plastic surfaces. Cleaning studies have reported that quaternary ammonium compounds and vinegar (acetic acid) are not effective in treated Candida auris- however, cleaning with chlorine bleach or hydrogen peroxide does seem to be effective in treating Candida auris.

 
References / Sources

1. Forsberg K, Woodworth K, Walters M, et al. Candida auris: The recent emergence of a multidrug-resistant fungal pathogen. Medical mycology. 2019;57(1):1-12.
2. Lockhart SR, Etienne KA, Vallabhaneni S, et al. Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses. Clin Infect Dis. 2017;64(2):134-140.