Candida auris: time to take note

Sharon Chen1 , Alice Kizny-Gordon2,  Jo Tallon3, George Kotsiou2, Bernard Hudson2, on behalf of the Australia and New Zealand Mycoses Interest Group, Australasian Society for Infectious Diseases

1 Centre for Infectious Diseases and Microbiology, ICPMR- NSW Health Pathology and Westmead Hospital, University of Sydney, Sydney, NSW 2145. sharon.chen@health.nsw.gov.au
2Department of Microbiology & Infectious Diseases, NSW Health Pathology and Royal North Shore Hospital Hospital, St Leonards, Sydney NSW 2065.
3Infection Prevention and Control, Royal North Shore Hospital, St Leonards, Sydney NSW 2065.

 

Candida auris is an emerging nosocomial fungal pathogen with the propensity to cause outbreaks in healthcare facilities, affecting adults and children/neonates. Rare prior to 2009, this species has been identified in 6 continents. Although most cases of infection/colonisation are from India, the Americas, S. Africa, U.K., Europe and Oman, Australia has chimed in with at least 5 cases (publications in press) identified in WA, Victoria and NSW challenging infection control and infectious diseases practitioners.

Risk factors for C. auris candidemia are similar to those associated with candidemia due to other Candida species such as intravascular catheters. However, diarrhoea and tetracycline use were recently identified as independent risks. Median time to infection in hospitals is 19 days. Crude in-hospital mortality of candidemia is 30-60%.

Public health consortia have ongoing alerts to report isolations of C. auris. This may challenge microbiology laboratories that perform only phenotypic identification of Candida because of misidentifications. Accurate identification of C. auris requires either DNA sequencing or MALDI-TOF MS (caveat: robust database). Up to 20% of strains exhibit high MICs to all major classes of antifungals. First-line treatment options include an echinocandin pending susceptibility results. There is no evidence to suggest that colonised patients require treatment.

The precise mode of transmission is also unclear. Many infected patients were exposed to an artificial device or undergone invasive procedures suggesting exogenous sources. C. auris can be found on bed rails, floors, sinks, in alcohol gel dispensers, and on healthcare worker hands. Colonised patients can spread infection. All infected /colonised patients should be cared for under strict contact precautions, and contact screening undertaken with groin and axilla swabs. Environmental cleaning protocols are required.

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