Candida auris, or C. auris, is a type of fungus that can lead to severe infections. First identified in Japan in 2009 from a patient’s ear canal, it has since been reported in over 40 countries. This pathogen has gained global attention as a serious and emerging public health concern. It represents a particular challenge within healthcare environments.
Understanding the Threat of Candida Auris
The public health challenge of Candida auris stems from factors that complicate treatment and control. A primary issue is its frequent resistance to multiple antifungal medications. Some strains have demonstrated resistance to all three main classes of available antifungal drugs, making treatment exceptionally difficult. This multidrug resistance means that infections can persist despite standard therapeutic approaches.
Another reason for concern is the difficulty in accurately identifying C. auris using standard laboratory techniques. It can be easily misidentified as other species of Candida yeast, which may lead to delayed or inappropriate management of the infection. This diagnostic challenge underscores the need for specialized laboratory methods.
The fungus’s capacity to cause prolonged outbreaks within healthcare facilities solidifies its status as a notable threat. It is adept at persisting on surfaces in the patient environment and on human skin for extended periods. This resilience contributes to its spread within hospitals and other long-term care settings, leading to a continuous cycle of transmission.
Transmission and High-Risk Environments
Candida auris spreads within healthcare settings through direct contact with a person who is infected or colonized, meaning they carry the fungus on their body without showing signs of illness. The fungus also spreads indirectly through contact with contaminated surfaces or medical equipment, such as bedside tables, blood pressure cuffs, and temperature probes.
The environments posing the highest risk for C. auris transmission are hospitals and long-term care facilities. Outbreaks are most common in these settings due to the concentration of susceptible individuals and the extensive use of invasive medical devices. The fungus has been found on a wide array of surfaces in patient rooms, including windowsills and sinks.
Certain factors increase an individual’s susceptibility to acquiring a C. auris infection. Risk is higher for those with a central venous catheter or other invasive medical devices, patients who have recently undergone surgery, and individuals with extended stays in healthcare facilities. A weakened immune system, chronic kidney disease, and diabetes are also recognized risk factors. It is important to note that C. auris rarely causes infections in healthy individuals outside of healthcare environments.
Signs of Infection and Diagnosis
The symptoms of an invasive Candida auris infection are often general and can be mistaken for other illnesses. Common signs include fever and chills that do not improve after antibiotic treatment for a presumed bacterial infection. The specific symptoms depend on the part of the body affected, as C. auris can cause infections in the bloodstream, wounds, and within the ear.
While it can be found in urine and respiratory samples, its role in causing bladder or lung infections is still being studied. A person can also be “colonized” with C. auris, carrying the fungus on their skin without any active infection. However, these individuals are still at risk for developing an infection later and can transmit the fungus to others.
Diagnosing a C. auris infection requires specific laboratory technologies because traditional methods for identifying yeast are often unreliable. Standard lab tests may misidentify it as a different species of Candida. Accurate identification depends on advanced methods such as Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) mass spectrometry or molecular techniques that analyze the organism’s genetic material.
Management and Prevention Strategies
Managing a Candida auris infection requires a specific class of antifungal medication known as echinocandins, as many strains are resistant to other drug types. Consultation with an infectious disease specialist is highly recommended to guide treatment. In some instances where resistance is extensive, a combination of multiple antifungals at high doses may be necessary.
Preventing the spread of C. auris in healthcare facilities involves stringent infection control protocols. Strict adherence to hand hygiene, performed with soap and water or an alcohol-based hand sanitizer, is necessary for all healthcare personnel. Thorough environmental cleaning and disinfection are also required, using disinfectants registered by the Environmental Protection Agency (EPA) that have demonstrated effectiveness against C. auris.
Another prevention strategy is the screening of patients to identify those who are colonized with the fungus but show no symptoms. Identifying these carriers allows facilities to implement appropriate precautions to prevent further spread. For patients known to be infected or colonized, healthcare workers use contact precautions, which involves wearing gowns and gloves during patient care. Isolating patients in single rooms when possible is another measure used to contain the spread.