scholarly journals What Do We Know about Candida auris? State of the Art, Knowledge Gaps, and Future Directions

2021 ◽  
Vol 9 (10) ◽  
pp. 2177
Author(s):  
Victor Garcia-Bustos ◽  
Marta D. Cabanero-Navalon ◽  
Amparo Ruiz-Saurí ◽  
Alba C. Ruiz-Gaitán ◽  
Miguel Salavert ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Current Evidence ◽  
Knowledge Gaps ◽  
Candida Auris ◽  
Future Directions ◽  
International Agencies ◽  
Health Authorities ◽  
Control And Prevention ◽  
Global Threat ◽  
Healthcare Associated

Candida auris has unprecedently emerged as a multidrug resistant fungal pathogen, considered a serious global threat due to its potential to cause nosocomial outbreaks and deep-seated infections with staggering transmissibility and mortality, that has put health authorities and institutions worldwide in check for more than a decade now. Due to its unique features not observed in other yeasts, it has been categorised as an urgent threat by the Centers for Disease Control and Prevention and other international agencies. Moreover, epidemiological alerts have been released in view of the increase of healthcare-associated C. auris outbreaks in the context of the COVID-19 pandemic. This review summarises the current evidence on C. auris since its first description, from virulence to treatment and outbreak control, and highlights the knowledge gaps and future directions for research efforts.

scholarly journals Two Candida auris Cases in Germany with No Recent Contact to Foreign Healthcare—Epidemiological and Microbiological Investigations

2021 ◽  
Vol 7 (5) ◽  
pp. 380
Author(s):  
Joerg Steinmann ◽  
Thomas Schrauzer ◽  
Lisa Kirchhoff ◽  
Jacques F. Meis ◽  
Peter-Michael Rath
Keyword(s):  
South Asian ◽  
Multidrug Resistant ◽  
Health Care Facilities ◽  
Candida Auris ◽  
Contact Precautions ◽  
Asian Clade ◽  
Care Facilities ◽  
Long Time ◽  
European Health ◽  
Healthcare Associated

Candida auris has become a global fungal public health threat. This multidrug-resistant yeast is associated with nosocomial intra- and interhospital transmissions causing healthcare-associated infections. Here, we report on two C. auris cases from Germany. The two patients stayed in Germany for a long time before C. auris was detected during their hospitalization. The patients were isolated in single rooms with contact precautions. No nosocomial transmissions were detected within the hospital. Both C. auris isolates exhibited high minimum inhibitory concentrations (MICs) of fluconazole and one isolate additionally high MICs against the echinocandins. Microsatellite genotyping showed that both strains belong to the South Asian clade. These two cases are examples for appropriate in-hospital care and infection control without further nosocomial spread. Awareness for this emerging, multidrug-resistant pathogen is justified and systematic surveillance in European health care facilities should be performed.

scholarly journals Outbreak investigation of Candida auris at a tertiary care hospital in Karachi, Pakistan

2020 ◽  
Vol 21 (5) ◽  
pp. 189-195
Author(s):  
Joveria Q Farooqi ◽  
Asad S Soomro ◽  
Mirza A Baig ◽  
Shamoona F Sajjad ◽  
Kamran Hamid ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Case Fatality ◽  
Multidrug Resistant ◽  
Outbreak Investigation ◽  
Care Hospital ◽  
Candida Auris ◽  
Control And Prevention ◽  
History Of ◽  
Age Range

Background: From September 2014, a tertiary care hospital in Karachi, Pakistan, started diagnosing 3–5 cases/month of a yeast locally identified as Saccharomyces spp. resistant to fluconazole. US Centers for Disease Control and Prevention identified the isolates as Candida auris. The Pakistan Field Epidemiology and Laboratory Training Program (FELTP) and the hospital investigated the outbreak from April 2015 to January 2016. Objective: The aim of the outbreak investigation was to determine the risk factors and to inform measures to limit the spread of the organism in the hospital. Methods: Medical records, nursing schedules and infection control practices were reviewed. Sixty-two age- and sex-matched hospital controls from the same wards were identified. Results: Thirty cases (17 males) were identified (mean age = 51.6 years, age range = 2–91 years), case fatality was 53%. Multivariate logistic regression showed that a history of surgery within 90 days of diagnosis, admission to the emergency department and history of chronic kidney disease were significantly associated with C. auris infection. Discussion: This is the report of the outbreak investigation that triggered a global exploration of C. auris as a newly identified multidrug-resistant nosocomial organism, spreading within the hospital, especially among patients with invasive procedures. Unfortunately, we could not identify any specific source of the outbreak nor stop the transmission of the organism.

scholarly journals 1687. High-Rates of Candida auris Carriage and Co-Colonization with Multidrug-Resistant Organisms (MDROs)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S617-S617
Author(s):  
Ruby Barza ◽  
Parul Patel ◽  
Jignesh Patel ◽  
Lauren E Droske ◽  
Donna Schora ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
High Rate ◽  
Diffusion Method ◽  
Candida Auris ◽  
Prevalence Survey ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Few Data ◽  
Healthcare Associated

Abstract Background Candida auris is an emerging multidrug-resistant pathogen that can persist in the environment and lead to healthcare-associated outbreaks. Residents of long-term acute care hospitals (LTACHs) are at particular risk for carriage of both MDROs and C. auris. However, there are few data on co-colonization rates of C. auris with other MDROs in LTACHs. Methods We conducted a point prevalence survey for MDROs, C. auris and C. difficile in a Chicago LTACH in March 2019. A combined axilla/groin E-swab (Copan) was collected and plated for C. auris isolation using CHROMagar Candida (Hardy). A rectal E-swab (Copan) was collected for C difficile PCR and MDRO detection including Carbapenem-resistant Enterobacteriaceae (CRE), Extended-spectrum B-lactamases (ESBLs) and Vancomycin-resistant Enterococci (VRE). Each swab was plated directly on VACC agar (Vancomycin, Amphotericin B, Ceftazidime, Clindamycin) and CHROMagar ESBL (Hardy). Bruker MALDI-TOF was used for bacterial and yeast identification and disc diffusion method for antimicrobial susceptibility testing. ESBL phenotypic confirmation was done using double-disc synergy method per CLSI guidelines. Carbapenemase production was confirmed using Xpert Carba-R assay (Cepheid). C. difficile PCR was performed using Xpert C. difficile/Epi assay (Cepheid). Results Of 38 patients 36 were eligible for the study (2 patients declined). Overall, 26/36 (72%) patients had an MDRO. Eight (22%) patients were positive for C. auris. Eight (22%) patients had ESBLs (2 P. mirabilis and 6 E. coli), six (17%) had CREs that were all blaKPC positive (4 K. pneumonia, 1 E. coli, and K. pneumoniae). Eight (22%) patients were positive for other gram-negative (GN)-MDROs including 1 A. baumanii, 3 P. aeruginosa, 2 E. cloacae, 1 E. asburiae and 1 P. aeruginosa, and A. baumanii. 20 patients (56%) had VRE colonization. Five (14%) were C. difficile PCR positive. 7/ 8 (87.5%) patients with C. auris were also colonized with another MDRO (2 VRE, 1 ESBL, 1 VRE, ESBL and KPC, 1 VRE and GN-MDRO, 1 VRE, ESBL and GN-MDRO, 1 VRE, KPC, and GN-MDRO). Conclusion We found a high rate of MDRO co-colonization among patients with C. auris carriage. Continuous active surveillance may be appropriate in LTACHs to limit the spread of C. auris and other MDROs. Disclosures All authors: No reported disclosures.

scholarly journals Klebsiella pneumoniae acquisition in ICUs: patient-based and laboratory-based surveillance

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Barchitta ◽  
A Maugeri ◽  
C La Mastra ◽  
MC La Rosa ◽  
L Sessa ◽  
...  
Keyword(s):  
Public Health ◽  
Intensive Care ◽  
High Risk ◽  
Klebsiella Pneumoniae ◽  
Intensive Care Units ◽  
Multidrug Resistant ◽  
Trauma Patients ◽  
Healthcare Associated Infections ◽  
Global Threat ◽  
Healthcare Associated

Abstract Klebsiella pneumoniae - and especially multidrug-resistant K. pneumoniae - represents a global threat for Public Health, due to its high dissemination in Intensive Care Units (ICUs) and its association with mortality. Here, we investigated the molecular epidemiology of multidrug-resistant K. pneumoniae strains in ICUs from Catania, Italy. We used data and samples from the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project, which has been surveying the epidemiology and the risk of Healthcare-associated infections (HAIs) in Italian ICUs. The SPIN-UTI network adopted the ECDC protocols for patient-based HAI surveillance. In a sample of ICUs the patient-based surveillance was integrated with a laboratory-based surveillance of MDR K. pneumoniae isolates. K. pneumoniae isolates were genotyped by multilocus sequence typing (MLST), and patterns of K. pneumoniae acquisition (i.e. carriage, colonization and infection) were identified using standard definitions. Our analysis included 155 patients who stayed in two ICUs for a total of 2254 days, from October 2016 to March 2017. Trauma patients were more likely to be infected with K. pneumoniae than other patients (OR = 5.9; 95%CI=2.4-14.8; p = 0.004). A total of 109 K. pneumoniae strains were isolated from different sites of 39 patients, which in turn were defined as 45.2% colonization, 25.8% infection, and 29% carriage. 79.3% K. pneumoniae isolates resistant to carbapenems and 100% resistant to penicillins and cephalosporins. The MLST identified two major clonal groups: the ST395 and the ST37, which represented respectively the 65.6% and the 21.3% of typed isolates. Surveillance of colonization and infection by high-risk clones might help in implementing appropriate strategies, which are crucial to reduce the spread of K. pneumoniae in ICUs. *Study Group AOU 'Policlinico-Vittorio Emanuele', Catania, Italy: Patrizia Bellocchi, Giacomo Castiglione, Alida Imbriani, Marinella Astuto, Giuseppa La Camera, Agata Sciacca Key messages Multidrug-resistant K. pneumoniae still represents a threat for Public Health in Italy and globally, due to its high dissemination in intensive care units. Surveillance of colonization and infection by high-risk clones might help in reducing the spread of Klebsiella pneumoniae.

scholarly journals Comparative molecular and immunoregulatory analysis of extracellular vesicles from Candida albicans and Candida auris

2020 ◽  
Author(s):  
Daniel Zamith-Miranda ◽  
Heino M. Heyman ◽  
Sneha P. Couvillion ◽  
Radames J. B. Cordero ◽  
Macio L. Rodrigues ◽  
...  
Keyword(s):  
Extracellular Vesicles ◽  
Pathogenic Fungus ◽  
Cell Monolayer ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Immune Defense ◽  
Potential Contribution ◽  
Candida Auris ◽  
Activation Markers ◽  
Healthcare Associated

AbstractCandida auris is a recently described multidrug-resistant pathogenic fungus that is increasingly responsible for healthcare associated outbreaks across the world. Bloodstream infections of this fungus cause death in up to 70% of the cases. Aggravating this scenario, C. auris’ disease-promoting mechanisms are poorly understood. Fungi release extracellular vesicles (EVs) carrying a broad range of molecules including proteins, lipids, carbohydrates, pigments, and RNA, many of which are virulence factors. Here, we carried out a comparative molecular characterization of C. auris and C. albicans EVs and evaluated their capacity to modulate effector mechanisms of host immune defense. Using proteomics, lipidomics, and transcriptomics, we found that C. auris released EVs with payloads that were strikingly different from EVs released by C. albicans. EVs released by C. auris potentiated the adhesion of this yeast to an epithelial cell monolayer. C. auris EVs also induced the expression of surface activation markers and cytokines by bone marrow-derived dendritic cells. Altogether, our findings show distinct profiles and properties of EVs released by C. auris and by C. albicans, and highlight the potential contribution of C. auris EVs to the pathogenesis of this emerging pathogen.

In vitro interaction of fluconazole and trimethoprim–sulfamethoxazole against Candida auris using ETEST and checkerboard methods

2020 ◽  
Vol 69 (1) ◽  
pp. 96-99
Author(s):  
Heather R Davis ◽  
Deborah S Ashcraft ◽  
George A Pankey
Keyword(s):  
Inhibitory Concentration ◽  
Multidrug Resistant ◽  
Broth Microdilution ◽  
Candida Auris ◽  
Bacterial Enzyme ◽  
Control And Prevention ◽  
In Vitro Interaction ◽  
Synergy Testing ◽  
In Vitro Interactions

Candida auris was discovered in 2009 and has rapidly emerged as a serious public health threat with cases reported in over 20 countries worldwide. As of May 8, 2020, the Centers for Disease Control and Prevention reported a total of 1122 US cases. C. auris is often multidrug resistant, leaving few options for treatment. Sulfonamides are known to inhibit a bacterial enzyme involved in folate synthesis and may also inhibit yeast organisms by a similar mechanism. The combination of trimethoprim and sulfamethoxazole is more commonly used than either drug alone. The objective of this study was to evaluate the combination of fluconazole and trimethoprim–sulfamethoxazole against C. auris. Minimum inhibitory concentrations (MICs) of fluconazole and trimethoprim–sulfamethoxazole were determined by ETEST and broth microdilution for 11 C. auris strains. Fluconazole MICs (µg/mL) were 4–>256 by ETEST and 2–>256 by broth microdilution (73% resistant); trimethoprim–sulfamethoxazole MICs were >32 by ETEST and 32–>128 by broth microdilution (no interpretive guidelines for C. auris). Using our MIC: MIC ETEST method and a checkerboard method, we investigated the interaction of fluconazole and trimethoprim–sulfamethoxazole against all isolates. These interactions were analyzed by calculating the summation fractional inhibitory concentration with synergyof ≤0.5, additivity of >0.5–1.0, indifference of >1–4, and antagonism of >4. The combination of fluconazole and trimethoprim–sulfamethoxazole revealed synergy with three (27%) and additivity with one (9%) isolate. Indifference was found for the remaining seven (64%) isolates. With the checkerboard method, synergy was seen in 1/11 (9%) isolates with fluconazole (½ MIC) plus trimethoprim–sulfamethoxazole (1/64 MIC); additivity, in 7/11 (64%) isolates with fluconazole (1/8 MIC–1×MIC) plus trimethoprim–sulfamethoxazole (1/128 MIC–½ MIC); and indifference in 3/11 (27%) isolates. Regardless, in vitro interactions may or may not correlate with clinical outcomes. Synergy testing with additional drug combinations and isolates should be performed.

scholarly journals Combined Antifungal Resistance and Biofilm Tolerance: the Global Threat of Candida auris

mSphere ◽  
2019 ◽  
Vol 4 (4) ◽  
Author(s):  
Ryan Kean ◽  
Gordon Ramage
Keyword(s):  
Clinical Importance ◽  
Multidrug Resistant ◽  
Antifungal Resistance ◽  
Antifungal Drugs ◽  
Medical Mycology ◽  
Candida Auris ◽  
Content Type ◽  
Echinocandin Resistance ◽  
Global Threat ◽  
The Impact

ABSTRACT The enigmatic yeast Candida auris has emerged over the last decade and rapidly penetrated our consciousness. The global threat from this multidrug-resistant yeast has generated a call to arms from within the medical mycology community. Over the past decade, our understanding of how this yeast has spread globally, its clinical importance, and how it tolerates and resists antifungal agents has expanded. This review highlights the clinical importance of antifungal resistance in C. auris and explores our current understanding of the mechanisms associated with azole, polyene, and echinocandin resistance. We also discuss the impact of phenotypic tolerance, with particular emphasis on biofilm-mediated resistance, and present new pipelines of antifungal drugs that promise new hope in the management of C. auris infection.

scholarly journals Outbreaks of Healthcare-Associated Infections in Sao Paulo State, Brazil: Results From a Statewide Monitoring System

2020 ◽  
Vol 41 (S1) ◽  
pp. s338-s338
Author(s):  
Heloisa de Jesus Marçal ◽  
Geraldine Madalosso ◽  
Denise Assis ◽  
Maria Clara Padoveze
Keyword(s):  
Health Department ◽  
Multidrug Resistant ◽  
Sao Paulo ◽  
Healthcare Associated Infections ◽  
São Paulo ◽  
State Health ◽  
Paulo State ◽  
Health Authorities ◽  
São Paulo State ◽  
Healthcare Associated

Background: Outbreaks of healthcare-associated infections (HAI) are relevant causes of morbidity and mortality. Healthcare-authorities should monitor them to allow prompt interventions, identify tendencies along the time, and develop large scale strategies to avoid new cases and clusters. According to the Brazilian legislation, any outbreak should be reported to health authorities. Sao Paulo State Health Department (Brazil) has a system in place since 2011 to monitor HAI outbreaks. This study aims at describing the 3.5 last year’s results of surveillance system for monitoring HAI outbreaks. Methods:Study design: Quantitative descriptive study. Source of information: Database from HAI outbreak reports, Division of Hospital Infection at Sao Paulo State Health Department. Reports were filled out online by professionals from healthcare settings or regional health authorities according to predefined criteria. Interventions were put in place by the health authorities based on the analysis of each situation in a timely manner. Variables analyzed: Number of reports, local, infection site, type of care unit, causative microorganisms, number of cases, and number of deaths. Results: The number of reports have been stable for 3 years: 2016 (n = 34, 34.7%), 2017 (n = 28, 28.6%), 2018 (n = 25, 25.5%) and the first semester of 2019 (n = 11, 11.2%). These reports encompassed 712 confirmed cases and 123 deaths. The reports were mainly about infection outbreaks; 6 reports were about colonization of multidrug-resistant microorganisms. The bloodstream was the most frequent infection site in the HAI outbreak reports (n = 37, 37.7%), followed by respiratory tract (n = 25, 25.5%), urinary tract (n = 10, 10.2%), and surgical wound (n = 9, 9.2%). HAI outbreaks happened more frequently in intensive care units, including neonatal, pediatric, and adult ICUs (n = 38, 38.8%), followed by clinical and general wards (n = 20, 20.4%), hemodialysis (n = 6, 6.1%), and surgical wards (n = 5, 5.1%). Among reported outbreaks, 62.2% occurred in the capital and the metropolitan region of São Paulo. Microorganisms causing the HAI outbreaks reports were mainly carbapenem resistant, both Klebsiella pneumoniae (n = 28, 28.5%) and Acinetobacter baumannii (n = 12, 12.2%), but carbapenem-susceptible Pseudomonas aeruginosa (n = 7, 7.1%) was also reported. Conclusions: HAI outbreaks reported to health authorities in Sao Paulo may represent only a minute percentage of the total outbreaks, most of which are still not being reported, despite the normative. However, the available data emphasize the importance of developing strategies for intensive care units and hemodialysis units that focus on reducing bloodstream infections caused by multidrug-resistant gram-negative organisms.Funding: NoneDisclosures: None

Prevalence, epidemiology and clinical outcome of Candida auris infections: Experience from a tertiary care hospital in Jaipur

2021 ◽  
pp. 004947552110286
Author(s):  
Daisy Bacchani ◽  
Ekadashi Rajni ◽  
Vishnu K Garg ◽  
Richa Sharma ◽  
Ved P Mamoria
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Care Hospital ◽  
Emerging Pathogen ◽  
Broad Spectrum Antibiotic ◽  
Candida Auris ◽  
History Of ◽  
Echinocandin Resistance ◽  
Healthcare Associated

Candida auris is identified as an emerging pathogen worldwide. It is multidrug resistant and causes invasive healthcare-associated infections. Our retrospective study was conducted to determine the prevalence and epidemiology of C. auris infections in a tertiary care hospital in Jaipur. 24 clinical C. auris strains were included, most being from urine. The majority patients needed intensive care and had at least one underlying co-morbid condition. A history of broad-spectrum antibiotic or antifungal usage was present in 85%. Fluconazole, voriconazole, amphotericin B and 5-fluorocytosine resistance was seen in 96, 42, 33 and 8% isolates respectively. No echinocandin resistance was noted.

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