An Update on the Recent Emergence of Candida auris
DOI:
https://doi.org/10.22270/ajdhs.v2i1.11Keywords:
Fungal infection, Candida, C. auris, Candidemia, Bloodstream infectionAbstract
The incidence of invasive fungal infections (IFI) caused by unusual pathogens is on the rise, partly driven by the increased population of immunocompromised patients. The emerging multidrug-resistant yeast pathogen Candida auris (C. auris) has been a source of concern as an agent of healthcare-associated infections. C. auris is emerging multidrug-resistant yeast that causes serious invasive infections with high mortality. It was first discovered in 2009, and since then, individual cases or outbreaks have been reported from over 20 countries on five continents. Controlling C. auris is challenging for several reasons: (1) it is resistant to multiple classes of antifungals, (2) it can be misidentified as other yeasts by commonly available Identification methods, and (3) because of its ability to colonize patients perhaps indefinitely and persist in the healthcare environment, it can spread between patients in healthcare settings. The transmissibility and high levels of antifungal resistance that are characteristic of C. auris set it apart from most other Candida species. A robust response that involves the laboratory, clinicians, and public health agencies is needed to identify and treat infections and prevent transmission. This review highlights epidemiology, pathogenesis, microbiological characteristics, clinical presentation, diagnostic challenges and treatment options of C. auris infections. Infection prevention measures to prevent spread of C. auris and special measures during an outbreak situation have also been reviewed. Rapid emergence of hospital onset C. auris is worrisome. Early diagnosis of C. auris is essential for better outcomes and the implementation of infection prevention measures. Lack of widespread awareness, absence of general availability of diagnostic testing methods, and limited options for treatment of C. auris infections make it a difficult-to-treat pathogen. Further studies are needed for better understanding of this emerging pathogen.
Keywords: Fungal infection, Candida, C. auris, Candidemia, Bloodstream infection
References
Mikulska M, Del Bono V, Ratto S, et al. Occurrence, presentation and treatment of candidemia. Expert Rev Clin Immunol. 2012; 8(8):755-65. https://doi.org/10.1586/eci.12.52
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; 64:134-140. https://doi.org/10.1093/cid/ciw691
Centers for Disease Control and Prevention. Clinical alert to US healthcare facilities: global Emergence of Invasive Infections Caused by the Multidrug-Resistant Yeast Candida auris [Internet] Atlanta: CDC; 2017.
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):134-40. https://doi.org/10.1093/cid/ciw691
Okinda EK, Castanheira M, Njuguna A, et al. Candidemia at a referral hospital in Sub-Saharan Africa: Emergence of Candida auris as a major pathogen. European Conference on Clinical Microbiology and Infectious diseases: 2014: Barcelona, Spain[Poster Session]
Magobo RE, Corcoran C, Seetharam S, et al. Candida auris-associated candidemia, South Africa. Emerg Infect Dis. 2014; 20(7):1250-1. https://doi.org/10.3201/eid2007.131765
Calvo B, Melo AS, Perozo-Mena A, et al. First report of Candida auris in America: Clinical and microbiological aspects of 18 episodes of candidemia. J Infect. 2016; 73(4):369-74. https://doi.org/10.1016/j.jinf.2016.07.008
Rudramurthy SM, Chakrabarti A, Paul RA, et al. Candida auris candidaemia in Indian ICUs: analysis of risk factors. J Antimicrob Chemother. 2017; 72(6):1794-801. https://doi.org/10.1093/jac/dkx034
Schelenz S, Hagen F, Rhodes JL, et al. First hospital outbreak of the globally emerging Candida auris in a European hospital. Antimicrob Resist Infect Control. 2016; 5:35. https://doi.org/10.1186/s13756-016-0132-5
Satoh K, Makimura K, Hasumi Y, et al. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol. 2009; 53(1):41-4. https://doi.org/10.1111/j.1348-0421.2008.00083.x
Kim MN, Shin JH, Sung H, et al. Candida haemulonii and closely related species at 5 university hospitals in Korea: identification, antifungal susceptibility, and clinical features. Clin Infect Dis. 2009; 48(6):e57-61. https://doi.org/10.1086/597108
Kumar D, Banerjee T, Pratap CB, et al. Itraconazole-resistant Candida auris with phospholipase, proteinase and hemolysin activity from a case of vulvovaginitis. J Infect Develop Countries. 2015; 9(4):435-7. https://doi.org/10.3855/jidc.4582
Khillan V, Rathore N, Kathuria S, et al. A rare case of breakthrough fungal pericarditis due to fluconazole-resistant Candida auris in a patient with chronic liver disease. JMM Case Rep. 2014. https://doi.org/10.1099/jmmcr.0.T00018
Lee WG, Shin JH, Uh Y, et al. First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol. 2011; 49(9):3139-42. https://doi.org/10.1128/JCM.00319-11
Azar MM, Turbett SE, Fishman JA, et al. Donor-derived transmission of Candida auris during lung transplantation. Clin Infect Dis. 2017. https://doi.org/10.1093/cid/cix460
Sipiczki M, Tap RM. Candida vulturna pro tempore sp. nov., a dimorphic yeast species related to the Candida haemulonis species complex isolated from flowers and clinical sample. Int J Syst Evol Microbiol. 2016; 66:4009-4015. https://doi.org/10.1099/ijsem.0.001302
Sherry L, Ramage G, Kean R et al. Biofilm-forming capability of highly virulent, multidrug-resistant Candida auris. Emerg Infect Dis. 2017; 23:328-331. https://doi.org/10.3201/eid2302.161320
Kathuria S, Singh PK, Sharma C et al. Multidrug-resistant Candida auris misidentified as Candida haemulonii: characterization by matrix-assisted laser desorption ionization-time of flight mass spectrometry and DNA sequencing and its antifungal susceptibility profile variability by Vitek 2, CLSI broth microdilution, and Etest method. J Clin Microbiol. 2015; 53:1823-1830. https://doi.org/10.1128/JCM.00367-15
Welsh RM, Bentz ML, Shams A, et al. Survival, persistence, and isolation of the emerging multidrug-resistant pathogenic yeast Candida auris on a plastic healthcare surface. J Clin Microbiol. 2017; 55:2996-3005. https://doi.org/10.1128/JCM.00921-17
Ben-Ami R, Berman J, Novikov A et al. Multidrug-resistant Candida haemulonii and C. auris, Tel Aviv, Israel. Emerg Infect Dis. 2017; 23:195-203. https://doi.org/10.3201/eid2302.161486
Borman AM, Szekely A, Johnson EM. Isolates of the emerging pathogen Candida auris present in the UK have several geographic origins. Med Mycol. 2017; 55:563-567. https://doi.org/10.1093/mmy/myw147
Larkin E, Hager C, Chandra J et al. The emerging pathogen Candida auris: growth phenotype, virulence factors, activity of antifungals, and effect of SCY- 078, a novel glucan synthesis inhibitor, on growth morphology and biofilm formation. Antimicrob Agents Chemother. 2017; 61:e02396-16. https://doi.org/10.1128/AAC.02396-16
Borman AM, Szekely A, Johnson EM. Comparative pathogenicity of United Kingdom isolates of the emerging pathogen Candida auris and other key pathogenic Candida species. mSphere. 2016; 1:e00189-16. https://doi.org/10.1128/mSphere.00189-16
Fakhim H, Vaezi A, Dannaoui E et al. Comparative virulence of Candida auris with Candida haemulonii, Candida glabrata and Candida albicans in a murine model. Mycoses. 2018; 61:377-382. https://doi.org/10.1111/myc.12754
Chatterjee S, Alampalli SV, Nageshan RK, Chettiar ST, Joshi S, Tatu US. Draft genome of a commonly misdiagnosed multidrug resistant pathogen Candida auris. BMC Genomics. 2015; 16:686. https://doi.org/10.1186/s12864-015-1863-z
Chowdhary A, Voss A, Meis JF. Multidrug-resistant Candida auris: 'new kid on the block' in hospital-associated infections. J Hosp Infect. 2016; 94(3):209-12. https://doi.org/10.1016/j.jhin.2016.08.004
Chowdhary A, Anil Kumar V, Sharma et al. Multidrug-resistant endemic clonal strain of Candida auris in India. European J Clin Microbiol Infect Dis.2014; 33(6):919-26. https://doi.org/10.1007/s10096-013-2027-1
Chowdhary A, Sharma C, Duggal S, et al. New clonal strain of Candida auris, Delhi, India. Emerg Infect Dis. 2013; 19(10):1670-3. https://doi.org/10.3201/eid1910.130393
Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention. Recommendations for identification of Candida auris. 2017; https://www.cdc.gov/fungal/candida-auris/recommendations.html.
Bishop L, Cummins M, Guy R et al. Guidance for the laboratory investigation, management and infection prevention and control for cases of Candida auris. Vol v 2.0. London: Public Health England. 2017.
Vallabhaneni S, Cleveland AA, Farley MM et al. Epidemiology and risk factors for echinocandin nonsusceptible Candida glabrata bloodstream infections: data from a large multisite population-based candidemia surveillance program, 2008-2014. Open Forum Infect Dis. 2015; 2:ofv163. https://doi.org/10.1093/ofid/ofv163
Lockhart SR, Iqbal N, Cleveland AA et al. Species identification and antifungal susceptibility testing of Candida bloodstream isolates from population-based surveillance studies in two U.S. cities from 2008 to 2011. J Clin Microbiol. 2012; 50:3435-3442. https://doi.org/10.1128/JCM.01283-12
Chowdhary A, Prakash A, Sharma C et al. A multicentre study of antifungal susceptibility patterns among 350 Candida auris isolates (2009-17) in India: role of the ERG11 and FKS1 genes in azole and echinocandin resistance. J Antimicrob Chemother. 2018; 73:891-899. https://doi.org/10.1093/jac/dkx480
Flowers SA, Colon B, Whaley SG, Schuler MA, Rogers PD. Contribution of clinically derived mutations in ERG11 to azole resistance in Candida albicans. Antimicrob Agents Chemother. 2015; 59:450-460. https://doi.org/10.1128/AAC.03470-14
Perlin DS. Mechanisms of echinocandin antifungal drug resistance. Ann N Y Acad Sci. 2015; 1354:1-11. https://doi.org/10.1111/nyas.12831
Pfaller MA, Espinel-Ingroff A, Canton E et al. Wild-type MIC distributions and epidemiological cutoff values for amphotericin B, flucytosine, and itraconazole and Candida spp. as determined by CLSI broth microdilution. J Clin Microbiol. 2012; 50:2040-2046. https://doi.org/10.1128/JCM.00248-12
Forsberg K, Woodworth K, Walters M, Berkow EL, Jackson B, Chiller T, Vallabhaneni S. Candida auris: The recent emergence of a multidrug-resistant fungal pathogen. Med Mycol. 2018; 0:1-12. https://doi.org/10.1093/mmy/myy054
Al-Siyabi T, Al Busaidi I, Balkhair A, Al-Muharrmi Z, Al-Salti M, Al'Adawi B. First report of Candida auris in Oman: clinical and microbiological description of five candidemia cases. J Infect. 2017; 75:373-376. https://doi.org/10.1016/j.jinf.2017.05.016
Rudramurthy SM, Chakrabarti A, Paul RA et al. Candida auris candidaemia in Indian ICUs: analysis of risk factors. J Antimicrob Chemother. 2017; 72:1794-1801. https://doi.org/10.1093/jac/dkx034
Navalkele BD, Revankar S, Chandrasekar P. Candida auris: A worrisome, globally emerging pathogen, Expert Rev Anti-infect Ther. 2017. https://doi.org/10.1080/14787210.2017.1364992
Kim TH, Kweon OJ, Kim HR, et al. Identification of uncommon candida species using commercial identification systems. J Microbiol Biotechnol. 2016; 26(12):2206-13. https://doi.org/10.4014/jmb.1609.09012
Prakash A, Sharma C, Singh A, et al. Evidence of genotypic diversity among Candida auris isolates by multilocus sequence typing, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and amplified fragment length polymorphism. Clin Microbiol Infect. 2016; 22(3):277.e1- 9. https://doi.org/10.1016/j.cmi.2015.10.022
Girard V, Mailler S, Chetry M, et al. Identification and typing of the emerging pathogen Candida auris by matrix-assisted laser desorption ionisation time of flight mass spectrometry. Mycoses. 2016; 59(8):535-8. https://doi.org/10.1111/myc.12519
Candida auris Interim Recommendations for Healthcare Facilities and Laboratories [Internet] Atlanta, CDC 2016.
Mizusawa M, Miller H, Green R, et al. Can multidrug-resistant candida auris be reliably identified in clinical microbiology laboratories. J Clin Microbiol. 2017; 55(2):638-40. https://doi.org/10.1128/JCM.02202-16
Kordalewska M, Zhao Y, Lockhart SR, et al. Rapid and accurate molecular identification of the emerging multidrug resistant pathogen Candida auris. J Clin Microbiol. 2017. https://doi.org/10.1128/JCM.00630-17
Borman AM, Szekely A, Johnson EM. Isolates of the emerging pathogen Candida auris present in the UK have several geographic origins. Med Mycol. 2017. https://doi.org/10.1093/mmy/myw147
Tsay S, Welsh RM, Adams EH, et al. notes from the field: ongoing transmission of candida auris in health care facilities - United States, June 2016-May 2017. MMWR Morb Mortal Wkly Rep. 2017; 66(19):514-5. https://doi.org/10.15585/mmwr.mm6619a7
Lepak AJ, Zhao M, Berkow EL, Lockhart SR, Andes DR. Pharmacodynamic optimization for treatment of invasive Candida auris infection. Antimicrob Agents Chemother. 2017; 61:e00791-17. https://doi.org/10.1128/AAC.00791-17
Fakhim H, Chowdhary A, Prakash A et al. In vitro interactions of echinocandins with triazoles against multidrug-resistant Candida auris. Antimicrob Agents Chemother. 2017; 61:e01056-17. https://doi.org/10.1128/AAC.01056-17
Berkow EL, Angulo D, Lockhart SR. In vitro activity of a novel glucan synthase inhibitor, SCY-078, against clinical isolates of Candida auris. Antimicrob Agents Chemother. 2017; 61: e00435-17. https://doi.org/10.1128/AAC.00435-17
Hager CL, Larkin EL, Long L, Zohra Abidi F, Shaw KJ, Ghannoum MA. In vitro and in vivo evaluation of the antifungal activity of APX001A/APX001 against Candida auris. Antimicrob Agents Chemother. 2018; 62:e02319-17. https://doi.org/10.1128/AAC.02319-17
Berkow EL, Lockhart SR. Activity of CD101, a long-acting echinocandin, against clinical isolates of Candida auris. Diagn Microbiol Infect Dis. 2018; 90:196-197. https://doi.org/10.1016/j.diagmicrobio.2017.10.021
Choi HI, An J, Hwang JJ, Moon SY, Son JS. Otomastoiditis caused by Candida auris: case report and literature review. Mycoses. 2017; 60:488-492. https://doi.org/10.1111/myc.12617
Lesho EP, BronsteinMZ, McGann P et al. Importation, mitigation, and genomic epidemiology of Candida auris at a large teaching hospital. Infect Control Hosp Epidemiol. 2018: 39:53-57. https://doi.org/10.1017/ice.2017.231
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