Multidrug-resistant Candida auris is an urgent antimicrobial resistance threat and the key method of C auris prevention is strict adherence to infection control measures, according to a short opinion paper published in the Annals of Internal Medicine.

Unlike other Candida spp, C auris is commonly transmitted between patients in healthcare settings and primarily colonizes the skin and nares. Currently, there are no known strategies for C auris decolonization.

C auris has demonstrated unprecedented levels of antimicrobial resistance: approximately 90% of isolates sampled in the United States are resistant to fluconazole, >40% to amphotericin B and 2% to echnocandins. Several strains have demonstrated resistance to all 3 classes of anti-fungals, and 40% are resistant to at least 2 of them.

The primary risk factors for C auris colonization and infection in the United States include receipt of healthcare in high-acuity or post-acute care settings, such as long-term acute care hospitals and/or nursing homes. Many patients have a history of stroke or other severe neurologic conditions, the presence of tracheostomies and percutaneous feeding tubes, and the inability to perform any activities of daily living. In addition, many patients with C auris colonization are also either colonized by or have a history of infection with other multidrug-resistant organisms, most prominently carbapenemase-producing, carbapenem-resistant Enterobacteriaceae. Further, frequent hospitalizations and receipt of multiple courses of very-broad-spectrum antibiotics, like carbapenems, are risk factors for C auris colonization.

Another known risk factor for infection or colonization is a history of hospitalization in a country with C auris transmission. For this reason, the United States Centers for Disease Control and Prevention recommends screening patients who have had an overnight hospitalization outside the United States in the previous year.

Although early identification is key to controlling C auris transmission, “many laboratories lack mycology capacity, and those that have it may not routinely determine yeast species, even in sterile site isolates,” according to the researchers.

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Antibiotic stewardship, improved maintenance practices for central venous catheters, and targeted antifungal prophylaxis are all required for preventing invasive Candida infections; however, the key difference for C auris prevention is strict adherence to infection control measures.

While much more needs to be learned about C auris, “preventing the spread of this organism is a priority that requires bolstering laboratory detection capacity, strengthening public health surveillance, and improving infection control practices, especially in postacute care settings,” concluded the researchers.

Reference

Vallabhaneni S, Jackson BR, Chiller TM. Candida auris: an emerging antimicrobial resistance threat [published online July 30, 2019]. Ann Intern Med. doi:10.7326/M19-2205