Candida Auris: An Emerging Global Health Problem

The first case of Candida auris was reported in Japan in 2009, where it was found in a patient's ear. Since then, Candida auris infections have spread, with more than 1400 cases reported in the U.S. alone in 2021.

C. auris lives on the skin for a long time and as long as two weeks on surfaces in lab studies. People can have C. auris on their skin without getting sick. Still, because of its lifespan, they are at risk of developing an infection if their immune system becomes compromised soon after exposure.

There are a few reasons why Candida auris is concerning to the CDC and other agencies worldwide. C. auris is especially dangerous in hospital settings as it can easily infect those already sick. Identifying C. auris in a lab is challenging, which leads to delayed treatment.

Because it is often resistant to the majority of drugs, the fungus can be difficult to treat even when caught early.

Candida auris has a high mortality rate, mainly because of its drug resistance. Multiple strains are resistant to one or two available antifungal drug classes, but some are resistant to all three, leaving few treatment options. C. auris tends to occur in clusters in healthcare settings because it is easily transmissible, and hospitalized patients are particularly vulnerable.

Candida auris is transmitted from person to person, which is different from other Candida species that typically arise from the person's own flora. C. auris thrives on the skin, particularly in the groin and armpits, and can colonize someone within days of exposure.

In addition to acquiring C. auris from another person, people can also get it from surfaces. It has been found in patients' rooms and on objects like chairs, blood pressure cuffs, pumps, ventilators, and beds. This fungus can survive on surfaces for as long as four weeks, making it easy to spread.

Symptoms of a Candida auris infection are similar to those of other fungal infections. It can colonize various areas of the body, including the nose, lungs, heart, liver, vagina, skin, ears, brain, and wounds. The most common symptoms are fever and chills that don't improve after antibiotics, though a person with a C. auris infection may develop a urinary tract infection, skin abscess, ear infection, or meningitis.

Risk factors for developing a Candida auris infection are similar to other Candida infections. People with diabetes mellitus, HIV, or cancer or who have received chemotherapy, hemodialysis, corticosteroids, a blood transfusion, or a transplant are at risk, as are those with an indwelling urinary catheter or central venous catheter.

People in the ICU or who have had surgery within 30 days are also more likely to develop a C. auris infection.

Drug resistance is the most challenging aspect of treating a Candida auris infection. One study showed that 25 percent of infections were resistant to multiple drugs. There is no standard treatment, and most cases are managed on a case-by-case basis according to susceptibility testing.

The CDC has put together tentative guidelines but recommends close monitoring for clinical improvement and repeating susceptibility testing to asses for drug resistance.

There are some treatment approaches in addition to antifungal medications. Once a doctor detects the infection, they remove any central venous catheters, urinary catheters, or other drains from the patient. If antifungal medication appears ineffective, doctors should monitor the patient for complications from the infection spreading, including endocarditis, abscesses, and eye problems.

The Infectious Disease Society of America indicates that patients should continue taking antifungal medication for two weeks, even if the cultures come back negative after the treatment.

Because they are so hard to treat, preventing Candida auris infections is essential. The best way to do so is to reduce the number of locations the fungus can enter the body. This means healthcare practitioners should be focused on keeping catheters and tracheostomy sites clean and well-maintained. Patients who have lines and tubes into their bodies should have these removed as soon as they are no longer needed.

Complications of Candida auris depend on the location and extent of the infection. Localized infections can lead to significant complications if they get into the bloodstream because once the fugus is in the bloodstream, it can spread throughout the body and eventually lead to multi-system organ failure.

In some cases, C. auris infections that spread via the blood become fatal.