Candida auris potentially deadly: Early detection key to prevent spread and emerging drug resistance

Candida Auris is a lethal fungus and therefore early detection is key to prevent fast spread and emergence of drug resistance.

Early identification of Candida auris, a potentially deadly fungus that causes bloodstream and intra-abdominal infections, is the key to controlling its spread. Its emergence has highlighted gaps in fungal identification capacity in the U.S. and around the world, and physicians should be on alert for risk factors. A commentary has been published in Annals of Internal Medicine.

This multidrug-resistant yeast, first reported in 2009 after it was found in the ear canal of a patient in Japan, has since caused invasive infections in more than 30 countries spanning every inhabited continent (1). It is an urgent threat because many strains are resistant to at least 2 of the 3 major classes of antifungal drugs used to treat Candida infections and because it causes outbreaks in health care settings to an extent not seen with other Candida species.

Candida auris distinguishes itself from other, more familiar Candida species in several ways. Its drug resistance is unprecedented among known human-pathogenic yeasts. In the United States, 90% of C auris isolates are resistant to fluconazole, more than 40% are resistant to amphotericin B, and approximately 2% are resistant to echinocandins (4); 40% are resistant to at least 2 classes of antifungal agents.

Candida auris is different from more familiar Candida species in several ways and its drug resistance is unprecedented among known human-pathogenic yeasts. Most Candida species are not believed to be transmitted in health care settings and do not require infection control measures when a patient develops an infection. However, unlike other Candida species, C auris is commonly transmitted between patients in health care settings, causing outbreaks that not only affect a single facility but also spread through networks of facilities. The ability of C auris to persist in and contaminate the health care environment and medical devices likely contributes to these outbreaks.

According to experts from the Centers for Disease Control and Prevention (CDC), previous hospitalization in a country with C auris transmission is a known risk factor for infection or colonization, as is receiving of health care in long-term acute care hospitals and nursing homes that take care of very sick patients who need long-term ventilators. Frequent hospitalizations and receiving of multiple courses of very-broad-spectrum antibiotics are also important risk factors. The authors suggest that being on high alert for these risk factors and screening appropriate patients is the key to controlling the spread of C auris.