Susceptibility of Candida auris and Candida albicans to 21 germicides used in healthcare facilities

Candida auris is an emerging fungal pathogen that is often resistant to major classes of antifungal drugs. It is considered a serious global health threat because it can cause severe infections with frequent mortality in more than a dozen countries. It can survive on healthcare environmental surfaces for at least 7 days and can cause outbreaks in healthcare facilities. Clearly, infection prevention strategies, such as surface disinfection, will be essential to controlling Candida transmission. Unfortunately, data on the activity of antiseptics and disinfectants used in healthcare to inactivate this pathogen are limited.1–5 In this study, we investigated 12 different disinfectants (ie, 8 low- and intermediate-level disinfectants in 2 dilutions of sodium hypochlorite and 5 high-level disinfectants/chemical sterilants) and 9 antiseptics commonly used in healthcare facilities for their antimicrobial activity against C. auris and C. albicans.

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Inactivation of Candida auris and Candida albicans by Ultraviolet-C

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.868 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s292-s292

Author(s):

William Rutala ◽

Hajime Kanamori ◽

Maria Gergen ◽

Emily Sickbert-Bennett ◽

David Jay Weber

Keyword(s):

Infection Prevention ◽

Antifungal Drugs ◽

Candida Auris ◽

Healthcare Facilities ◽

Environmental Surfaces ◽

Route Of Transmission ◽

Indirect Exposure ◽

Ultraviolet C ◽

Severe Infections ◽

Uv C

Background:Candida auris is an emerging fungal pathogen that is often resistant to major classes of antifungal drugs. It is considered a serious global health threat because it has caused severe infections with frequent mortality in over a dozen countries. C. auris can survive on healthcare environmental surfaces for at least 7 days, and it causes outbreaks in healthcare facilities. C. auris has an environmental route of transmission. Thus, infection prevention strategies, such as surface disinfection and room decontamination technologies (eg, ultraviolet [UV-C] light), will be essential to controlling transmission. Unfortunately, data are limited regarding the activity of UV-C to inactivate this pathogen. In this study, a UV-C device was evaluated for its antimicrobial activity against C. auris and C. albicans. Methods: We tested the antifungal activity of a single UV-C device using the vegetative bacteria cycle, which delivers a reflected dose of 12,000 µW/cm2. This testing was performed using Formica sheets (7.6 × 7.6 cm; 3 × 3 inches). The carriers were inoculated with C. auris or C. albicans and placed horizontal on the surface or vertical (ie, perpendicular) to the vertical UV-C lamp and at a distance from 1. 2 m (~4 ft) to 2.4 m (~8 ft). Results: Direct UV-C, with or without FCS (log10 reduction 4.57 and 4.45, respectively), exhibited a higher log10 reduction than indirect UV-C for C. auris (log10 reduction 2.41 and 1.96, respectively), which was statistically significant (Fig. 1 and Table 1). For C. albicans, although direct UV-C had a higher log10 reduction (log10 reduction with and without FCS, 5.26 and 5.07, respectively) compared to indirect exposure (log10 reduction with and without FCS, 3.96 and 3.56, respectively), this difference was not statistically significant. The vertical UV had statistically higher log10 reductions than horizontal UV against C. auris and C. albicans with FCS and without FCS. For example, for C. auris with FCS the log10 reduction for vertical surfaces was 4.92 (95% CI 3.79, 6.04) and for horizontal surfaces the log10 reduction was 2.87 (95% CI, 2.36–3.38). Conclusions:C. auris can be inactivated on environmental surfaces by UV-C as long as factors that affect inactivation are optimized (eg, exposure time). These data and other published UV-C data should be used in developing cycle parameters that prevent contaminated surfaces from being a source of acquisition by staff or patients of this globally emerging pathogen.Funding: NoneDisclosures: None

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Environmental Surfaces in Healthcare Facilities are a Potential Source for Transmission ofCandida aurisand OtherCandidaSpecies

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.127 ◽

2017 ◽

Vol 38 (9) ◽

pp. 1107-1109 ◽

Cited By ~ 76

Author(s):

Christina T. Piedrahita ◽

Jennifer L. Cadnum ◽

Annette L. Jencson ◽

Aaron A. Shaikh ◽

Mahmoud A. Ghannoum ◽

...

Keyword(s):

Fungal Pathogen ◽

Laboratory Testing ◽

Multidrug Resistant ◽

Infect Control Hosp ◽

Hospital Environment ◽

Candida Auris ◽

Healthcare Facilities ◽

Potential Source ◽

Environmental Surfaces

Contaminated surfaces have been implicated as a potential route for dissemination of the emerging multidrug-resistant fungal pathogenCandida auris. In laboratory testing,C. aurisand otherCandidaspecies persisted for 7 days on moist or dry surfaces.Candidaspecies were recovered frequently from the hospital environment, particularly from moist surfaces.Infect Control Hosp Epidemiol2017;38:1107–1109

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1579. Multidrug-Resistant Candida auris Isolates From New York Hospitals and Healthcare Facilities Are Susceptible to Antifungal Combinations

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1443 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S576-S577

Author(s):

Brittany O’Brien ◽

Sudha Chaturvedi ◽

Vishnu Chaturvedi

Keyword(s):

New York ◽

Diagnostic System ◽

Multidrug Resistant ◽

Drug Combinations ◽

Antifungal Drugs ◽

Drug Resistant ◽

Candida Auris ◽

Current Case ◽

Healthcare Facilities ◽

Broth Microdilution Method

Abstract Background Candida auris outbreak continues unabated in New York with the current case counts exceeding 300 patients. We used a modification of standard CLSI broth microdilution method (BMD) if two-drug combinations are efficacious against C. auris isolates with high-resistance to fluconazole (FZ, MIC50 >256 mg/L), and variable resistance to other broad-spectrum antifungal drugs. Methods BMD plates were custom-designed and quality controlled by TREK Diagnostic System. The combination tests of 15 drug-resistant C. auris involved microtiter wells with the initial 144 two-drug combinations and their two-fold dilutions (1/2–1/32) to get 864 two-drug combinations finally. We utilized MIC100 endpoints for the drug combination readings as reported earlier for the intra- and inter-laboratory agreements obtained against Candida species and Aspergillus fumigatus (Antimicrob Agents Chemother. 2015. 59:1759–1766). We also tested minimum fungicidal concentrations (MFC). Results We tested all possible 864 two-drug antifungal combinations for nine antifungal drugs in use to yield 12,960 MIC100 readings, and MFC readings for 15 C. auris isolates. Flucytosine (FLC) at 2.0 mg/L potentiated most successful combinations with other drugs. Micafungin (MFG), Anidulafungin (AFG), Caspofungin (CAS) at individual concentrations of 0.25 mg/L combined well with FLC (2.0 mg/L) to yield MIC100 for 14, 13, and 12 of 15 C. auris isolates tested, respectively. MFG/FLC combination was also fungicidal for 4 of 15 isolates. AMB / FLC (0.25/1.0 mg/L) yielded MIC100 for 13 isolates and MFC for three test isolates. Posaconazole (POS), and Isavuconazole (ISA) and Voriconazole (VRC) also combined well with FLC (0.25/2.0 mg/L) to yield MIC100 for 12, 13, and 13 isolates, respectively. POS/FLC combination was fungicidal for three isolates. Conclusion We identified seven two drug-combinations of antifungals efficacious against drug-resistant C. auris strains. The modified BMD combination susceptibility testing could be used by the clinical laboratories to assist providers with the selection of optimal treatment for C. auris candidemia. Disclosures All authors: No reported disclosures.

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Candida auris: a fungus with identity crisis

Pathogens and Disease ◽

10.1093/femspd/ftaa034 ◽

2020 ◽

Vol 78 (4) ◽

Author(s):

Taissa Vila ◽

Ahmed S Sultan ◽

Daniel Montelongo-Jauregui ◽

Mary Ann Jabra-Rizk

Keyword(s):

Fungal Species ◽

Antifungal Drugs ◽

Multiple Drug ◽

Rapid Diagnostics ◽

Contributing Factors ◽

Candida Auris ◽

Healthcare Facilities ◽

Drug Classes ◽

Recent Emergence ◽

Robust Response

ABSTRACT Candida auris is a new fungal species that has puzzlingly and simultaneously emerged on five continents. Since its identification in 2009, the scientific community has witnessed an exponential emergence of infection episodes and outbreaks in healthcare facilities world-wide. Candida auris exhibits several concerning features compared to other related Candida species, including persistent colonization of skin and nosocomial surfaces, ability to resist common disinfectants and to spread rapidly among patients. Resistance to multiple drug classes and misidentification by available laboratory identification systems has complicated clinical management, and outcomes of infection have generally been poor with mortality rates approaching 68%. Currently, the origins of C. auris are unclear, and therefore, it is impossible to determine whether environmental and climactic changes were contributing factors in its recent emergence as a pathogen. Nevertheless, a robust response involving rapid diagnostics, prompt interventions and implementation of precautions, are paramount in curtailing the spread of infections by this fungal species. Importantly, there is a pressing need for the development of new antifungal drugs. In this article, we present a brief overview highlighting some of the important aspects of C. auris epidemiology, pathogenesis and its puzzling global emergence.

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Echinocandins as Biotechnological Tools for Treating Candida auris Infections

Journal of Fungi ◽

10.3390/jof6030185 ◽

2020 ◽

Vol 6 (3) ◽

pp. 185

Author(s):

Elizabete de Souza Cândido ◽

Flávia Affonseca ◽

Marlon Henrique Cardoso ◽

Octavio Luiz Franco

Keyword(s):

Fungal Pathogen ◽

Pathogenic Fungi ◽

Antifungal Drugs ◽

Healthcare Associated Infections ◽

Candida Auris ◽

High Interest ◽

The Past ◽

Recent Emergence ◽

Echinocandin Resistance ◽

Healthcare Associated

Candida auris has been reported in the past few years as an invasive fungal pathogen of high interest. Its recent emergence in healthcare-associated infections triggered the efforts of researchers worldwide, seeking additional alternatives to the use of traditional antifungals such as azoles. Lipopeptides, specially the echinocandins, have been reported as an effective approach to control pathogenic fungi. However, despite its efficiency against C. auris, some isolates presented echinocandin resistance. Thus, therapies focused on echinocandins’ synergism with other antifungal drugs were widely explored, representing a novel possibility for the treatment of C. auris infections.

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Relative Resistance of the Emerging Fungal Pathogen Candida auris and Other Candida Species to Killing by Ultraviolet Light

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.239 ◽

2017 ◽

Vol 39 (1) ◽

pp. 94-96 ◽

Cited By ~ 26

Author(s):

Jennifer L. Cadnum ◽

Aaron A. Shaikh ◽

Christina T. Piedrahita ◽

Annette L. Jencson ◽

Emily L. Larkin ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Candida Species ◽

Fungal Pathogen ◽

Laboratory Testing ◽

Multidrug Resistant ◽

Relative Resistance ◽

Candida Auris ◽

Healthcare Facilities ◽

Ultraviolet C ◽

Uv C

Mobile ultraviolet-C (UV-C) light room decontamination devices are frequently used as an adjunct to standard cleaning in healthcare facilities, but their efficacy in killing Candida species is not clear. In laboratory testing, the emerging multidrug-resistant Candida auris and 2 other Candida species were significantly less susceptible to killing by UV-C than methicillin-resistant Staphylococcus aureus.Infect Control Hosp Epidemiol 2018;39:94–96

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Molecular Diagnostics in the Times of Surveillance for Candida auris

Journal of Fungi ◽

10.3390/jof5030077 ◽

2019 ◽

Vol 5 (3) ◽

pp. 77 ◽

Cited By ~ 8

Author(s):

Milena Kordalewska ◽

David S. Perlin

Keyword(s):

Dna Amplification ◽

Antifungal Drugs ◽

Infection Prevention And Control ◽

Diagnostic Tools ◽

Candida Auris ◽

Accurate Identification ◽

Healthcare Facilities ◽

Antifungal Drug Resistance ◽

The Times ◽

Almost All

Recently, global health professionals have been significantly challenged by the emergence of Candida auris and its propensity to colonize human skin, persist in the healthcare environment, and cause healthcare-associated outbreaks. Additionally, C. auris isolates are often characterized by elevated minimal inhibitory concentration (MIC) values for antifungal drugs. Thus, rapid detection and accurate identification of C. auris together with an assessment of potential antifungal drug resistance has become essential for effective patient management, and infection prevention and control in healthcare facilities. Surprisingly, almost all of the commonly available diagnostic tools rely on recovery (growth) of yeast colonies from collected samples, which delays the diagnostic result by several days or longer. To circumvent these issues, molecular-based DNA amplification assays have been developed to identify C. auris DNA directly from patient samples. Moreover, allele discriminating detection probes can be used to rapidly assess validated mechanisms of echinocandin and azole resistance.

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Hog1 Regulates Stress Tolerance and Virulence in the Emerging Fungal PathogenCandida auris

mSphere ◽

10.1128/msphere.00506-18 ◽

2018 ◽

Vol 3 (5) ◽

Cited By ~ 18

Author(s):

Alison M. Day ◽

Megan M. McNiff ◽

Alessandra da Silva Dantas ◽

Neil A. R. Gow ◽

Janet Quinn

Keyword(s):

Protein Kinase ◽

Stress Resistance ◽

Fungal Pathogen ◽

Antifungal Drugs ◽

Control Measures ◽

Emerging Pathogen ◽

Candida Auris ◽

Content Type ◽

Resistance Profile

ABSTRACTCandida aurishas recently emerged as an important, multidrug-resistant fungal pathogen of humans. Comparative studies indicate that despite high levels of genetic divergence,C. aurisis as virulent as the most pathogenic member of the genus,Candida albicans. However, key virulence attributes ofC. albicans, such as morphogenetic switching, are not utilized byC. auris, indicating that this emerging pathogen employs alternative strategies to infect and colonize the host. An important trait required for the pathogenicity of many fungal pathogens is the ability to adapt to host-imposed stresses encountered during infection. Here, we investigated the relative resistance ofC. aurisand other pathogenicCandidaspecies to physiologically relevant stresses and explored the role of the evolutionarily conserved Hog1 stress-activated protein kinase (SAPK) in promoting stress resistance and virulence. In comparison toC. albicans,C. aurisis relatively resistant to hydrogen peroxide, cationic stress, and cell-wall-damaging agents. However, in contrast to otherCandidaspecies examined,C. auris was unable to grow in an anaerobic environment and was acutely sensitive to organic oxidative-stress-inducing agents. An analysis ofC. aurishog1Δ cells revealed multiple roles for this SAPK in stress resistance, cell morphology, aggregation, and virulence. These data demonstrate thatC. aurishas a unique stress resistance profile compared to those of other pathogenicCandidaspecies and that the Hog1 SAPK has pleiotropic roles that promote the virulence of this emerging pathogen.IMPORTANCEThe rapid global emergence and resistance ofCandidaauristo current antifungal drugs highlight the importance of understanding the virulence traits exploited by this human fungal pathogen to cause disease. Here, we characterize the stress resistance profile ofC. aurisand the role of the Hog1 stress-activated protein kinase (SAPK) in stress resistance and virulence. Our findings thatC. aurisis acutely sensitive to certain stresses may facilitate control measures to prevent persistent colonization in hospital settings. Furthermore, our observation that the Hog1 SAPK promotesC. aurisvirulence akin to that reported for many other pathogenic fungi indicates that antifungals targeting Hog1 signaling would be broad acting and effective, even on emerging drug-resistant pathogens.

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Adenylyl Cyclase and Protein Kinase A Play Redundant and Distinct Roles in Growth, Differentiation, Antifungal Drug Resistance, and Pathogenicity of Candida auris

mBio ◽

10.1128/mbio.02729-21 ◽

2021 ◽

Author(s):

Ji-Seok Kim ◽

Kyung-Tae Lee ◽

Myung Ha Lee ◽

Eunji Cheong ◽

Yong-Sun Bahn

Keyword(s):

Drug Resistance ◽

Protein Kinase ◽

Protein Kinase A ◽

Fungal Pathogen ◽

Fungal Pathogens ◽

Antifungal Drugs ◽

Candida Auris ◽

Content Type ◽

Antifungal Drug Resistance ◽

Kinase A

Despite the recently growing concern of pan-resistant Candida auris infection, the pathogenicity of this ascomycetous fungal pathogen and the signaling circuitries governing its resistance to antifungal drugs are largely unknown. Therefore, we analyzed the pathobiological functions of cyclic AMP (cAMP)/protein kinase A (PKA) signaling pathway in C. auris , which plays conserved roles in the growth and virulence of fungal pathogens.

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Molecular Epidemiological Investigation of a Nosocomial Cluster of C. auris: Evidence of Recent Emergence in Italy and Ease of Transmission during the COVID-19 Pandemic

Journal of Fungi ◽

10.3390/jof7020140 ◽

2021 ◽

Vol 7 (2) ◽

pp. 140

Author(s):

Vincenzo Di Pilato ◽

Giulia Codda ◽

Lorenzo Ball ◽

Daniele Roberto Giacobbe ◽

Edward Willison ◽

...

Keyword(s):

Infection Prevention ◽

Control Strategies ◽

Antifungal Susceptibility ◽

Hospital Setting ◽

Infection Prevention And Control ◽

Recent Event ◽

Candida Auris ◽

Recent Emergence ◽

High Level ◽

And Control

Candida auris is an emerging MDR pathogen raising major concerns worldwide. In Italy, it was first and only identified in July 2019 in our hospital (San Martino Hospital, Genoa), where infection or colonization cases have been increasingly recognized during the following months. To gain insights into the introduction, transmission dynamics, and resistance traits of this fungal pathogen, consecutive C. auris isolates collected from July 2019 to May 2020 (n = 10) were subjected to whole-genome sequencing (WGS) and antifungal susceptibility testing (AST); patients’ clinical and trace data were also collected. WGS resolved all isolates within the genetic clade I (South Asian) and showed that all but one were part of a cluster likely stemming from the index case. Phylogenetic molecular clock analyses predicted a recent introduction (May 2019) in the hospital setting and suggested that most transmissions were associated with a ward converted to a COVID-19-dedicated ICU during the pandemic. All isolates were resistant to amphotericin B, voriconazole, and fluconazole at high-level, owing to mutations in ERG11(K143R) and TACB1(A640V). Present data demonstrated that the introduction of MDR C. auris in Italy was a recent event and suggested that its spread could have been facilitated by the COVID-19 pandemic. Continued efforts to implement stringent infection prevention and control strategies are warranted to limit the spread of this emerging pathogen within the healthcare system.

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