Candida auris
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Etiology
- appears to be nosocomial infection
- specific risk factors not yet identified
- 41% with diabetes mellitus
- 51% with recent surgery
- 73% with central venous catheter
- 41% with recent antifungal therapy
- 63% male
Epidemiology
- Japan, South Korea , India, Kuwait, Pakistan
- South Africa
- Colombia, Venezuela
- United Kingdom
- patients of all ages
- clonality of isolates indicate almost simultaneous emergence of C auris in disparate parts of the world[3]
- 7 cases reported in the U.S., all survived[3]
- 77 clinical cases of Candida auris in U.S. June 2016-May 2017
- 53 in New York, 16 in New Jersey[4]
- all cases found on cultures during routine patient care
- Candida auris also isolated from patients' mattresses, windowsills, chairs, & countertops[4]
- outbreak linked to reusable axillary temperature probes in ICU[5]
- 3 cases in New York 2019 with isolates resistant to fluconazole. amphotericin B & echinocandins[7]
- highly-resistant Candida auris often colonizes skin of long-term facility residents[9]
- large increase in cases in 2021, with increase in echinocandin resistance[10]
- the rise in global temperatures, attributed to climate chang is believed to be a key factor behind the alarming surge of C. auris cases[11]
- Four cases of C. auris reported in Seattle WA Jan 2024[11]
- C. auris colonizes the skin often in the armpits & groin, but also in nostrils, fingertips, & palms which facilitated spreading
- chlorhexidine gluconate not completely effective in eradicating C. auris
- C. auris lingers on surfaces
- can survive on plastic for multiple weeks[11][12]
- healthcare-grade disinfectants for surfaces are not completely effective
Laboratory
- Candida auris ITS2 gene in specimen
- commercially available biochemical tests cannot differentiate C auris from other Candida species
- resistance to fluconazole (86-93%)[4]
- 35-43% resistant to amphotericin B[4]
- > 1/2 are resistant to voriconazole
- some isolates are resistant to echinocandin[4]
- resistance to 2 classes of anti-fungal agents (41%)[3]
- some isolates are resistant to all 3 major classes of antifungal drugs
Clinical significance
- largely nosocomial infection with risk factors for Candidiasis
- multidrug-resistant yeast[1][2]
- causes invasive disease, especially fungemia (60%)[3]
- high mortality (60%)[1]
Management
- lopinavir synergistic with itraconazole against multidrug-resistant Candida auris[8]
- chlorhexidine gluconate at concentrations > 625 ug/mL (0.0625%) reduces Candica auris skin colonization[9]
Notes
- first described in 2009 after isolation from external ear discharge in Japan[1]
More general terms
References
- ↑ 1.0 1.1 1.2 1.3 Centers for Disease Control & Prevention (CDC) Clinical Alert to U.S. Healthcare Facilities Global Emergence of Invasive Infections Caused by the Multidrug- Resistant Yeast Candida auris. http://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-alert.html
Candida auris Questions and Answers http://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-qanda.html - ↑ 2.0 2.1 Vallabhaneni S, Kallen A, Tsay S, et al. Investigation of the First Seven Reported Cases of Candida auris, a Globally Emerging Invasive, Multidrug-Resistant Fungus - United States, May 2013-August 2016. MMWR Morb Mortal Wkly Rep. ePub: 4 November 2016. https://www.cdc.gov/mmwr/volumes/65/wr/mm6544e1.htm
- ↑ 3.0 3.1 3.2 3.3 3.4 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 Jan 15; 64:134. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27988485 <Internet> http://cid.oxfordjournals.org/content/64/2/134
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 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;66:514-515. https://www.cdc.gov/mmwr/volumes/66/wr/mm6619a7.htm
- ↑ 5.0 5.1 Eyre DW, Sheppard AE, Madder E et al A Candida auris Outbreak and Its Control in an Intensive Care Setting. N Engl J Med 2018; 379:1322-1331. Oct 4, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30281988 https://www.nejm.org/doi/full/10.1056/NEJMoa1714373
- ↑ Bradley SF. JAMA Insights. Clinical Update. What Is Known About Candida auris. JAMA. Published online September 6, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31490531 https://jamanetwork.com/journals/jama/fullarticle/2749798
- ↑ 7.0 7.1 Ostrowsky B, Greenko J, Adams E, et al. Candida auris Isolates Resistant to Three Classes of Antifungal Medications - New York, 2019. MMWR Morb Mortal Wkly Rep 2020;69:6-9 https://www.cdc.gov/mmwr/volumes/69/wr/mm6901a2.htm
- ↑ 8.0 8.1 Eldesouky HE, Salama EA, Lanman NA et al. Potent synergistic interactions between lopinavir and azole antifungal drugs against emerging multidrug-resistant Candida auris. Antimicrob Agents Chemother 2020 Oct 12; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33046487 https://aac.asm.org/content/early/2020/10/06/AAC.00684-20
- ↑ 9.0 9.1 9.2 Stone J Untreatable, Drug-Resistant Fungus Found in Texas and Washington, DC Medscape - Jul 30, 2021. https://www.medscape.com/viewarticle/955789
Proctor DM, Dangana T, Sexton DJ et al. Integrated genomic, epidemiologic investigation of Candida auris skin colonization in a skilled nursing facility. Nat Med 2021 Jun 21; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34155414 https://www.nature.com/articles/s41591-021-01383-w
Lyman M, Forsberg K, Reuben J et al. Notes from the Field: Transmission of pan-resistant and echinocandin-resistant Candida auris in health care facilities - Texas and the District of Columbia, January-April 2021. MMWR Morb Mortal Wkly Rep 2021 Jul 23; 70:1022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34292928 Free article https://www.cdc.gov/mmwr/volumes/70/wr/mm7029a2.htm - ↑ 10.0 10.1 Lyman M et al Worsening Spread of Candida auris in the United States, 2019 to 2021. Ann Intern Med. 2023. March 21. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36940442 https://www.acpjournals.org/doi/10.7326/M22-3469
- ↑ 11.0 11.1 11.2 11.3 Wheat S, Kuczmarski T. There's a New Fungus in Town and It Won't Be the Last. The arrival of C. auris in Washington is a harbinger of health systems addled by climate change. MedPage Today. March 22, 2024 https://www.medpagetoday.com/opinion/second-opinions/109323
Putka S Candida Auris: What to Know About the Fungal Infection Spreading Across the U.S. The multidrug-resistant organism colonizes skin, lingers on surfaces. MedPage Today February 6, 2024 https://www.medpagetoday.com/special-reports/features/108600
Ellwanger JH, Chies JAB Candida auris emergence as a consequence of climate change: Impacts on Americas and the need to contain greenhouse gas emissions. Lancet Regional Health America. 2022. 1:100250. April 1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36778933 PMCID: PMC9903910 Free PMC Article https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(22)00067-9/fulltext - ↑ 12.0 12.1 Horton MV, Holt AM, Nett JE. Mechanisms of pathogenicity for the emerging fungus Candida auris. PLoS Pathog. 2023 Dec 21;19(12):e1011843. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38127686 Free PMC article. PMCID: PMC10735027 Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10735027/