Candida auris has garnered extensive coverage in the medical and lay press lately. This emerging fungal infection is spreading rapidly, leading to a number of outbreaks. Health care providers in a range of settings must grapple with the unique challenges of this pathogen, which can persist in the environment and frequently displays antifungal resistance. This virtual MSGERC Grand Rounds Webinar brought together experts in Candida auris epidemiology, infection control and prevention, and management. The experts tailored the content to address the most frequently submitted questions. The webinar also provide an opportunity for participants to ask questions in real time. Join us and be in the know about Candida auris.
Recorded: Monday, April 17, 2023
Dr. Meghan Lyman: Yes.
Dr. Meghan Lyman: There is not great data on this and often patients were not being tested routinely to identify when resistance developed. But hopefully, we will start to learn more about the development of echinocandin resistance in patients on treatment.
More details about the first three cases can be found here: https://www.cdc.gov/mmwr/volumes/69/wr/mm6901a2.htm
Dr. Meghan Lyman: Patients can remain colonized for a very long time, even years. But we don’t have great information/data about patient outcomes for infections of C auris.
Dr. Meghan Lyman: We don’t know for sure, but antibiotics could affect their microbiome and kill bacteria (and maybe other microbes like fungi), allowing a clean slate for C auris to grow and take over.
Dr. Meghan Lyman: There is no national outcome data or data comparing outcomes between clades, so we don’t know, but no signals that we’ve noted so far.
Dr. Meghan Lyman: Here is a recent report about the increase in cases/outbreaks in Europe:
Dr. Meghan Lyman: C auris can be found in urine, but we don’t know how sensitive or specific urine samples are for identifying colonized patients (compared to axilla/groin skin swabs).
Dr. Meghan Lyman: C auris is nationally notifiable although there is not great surveillance data provided to CDC about risk factors. However, anecdotally, we do not hear about C auris cases or outbreaks being more common among patients with typical immunocompromising conditions, like transplant, malignancy, or chemo. However, patients with C auris often are very ill and have different underlying conditions/risk factors (like invasive medical devices, broad spectrum antimicrobials, etc) that may impact their immune system and microbiome.
Dr. Meghan Lyman: There are currently no established C auris-specific susceptibility breakpoints. Therefore, tentative breakpoints have been defined based on those established for closely related Candida species and on expert opinion. The correlation between microbiologic breakpoints and clinical outcomes is not known at this time.
You can find the tentative breakpoints here: https://www.cdc.gov/fungal/candida-auris/c-auris-antifungal.html
Dr. Meghan Lyman: CDC currently recommends screening for C auris colonization using a composite swab of the patient’s bilateral axilla and groin. Available data suggest that these sites are the most common and consistent sites of colonization, but C auris can colonize other body sites and research continues to evaluate other body sites for use in screening.
Dr. Meghan Lyman: A donor-derived infection caused by C auris has been reported related to a lung transplant: https://academic.oup.com/cid/article/65/6/1040/3830200. However, there are no official recommendations at this time and it might depend on the local prevalence and risk factors of the donor.
Dr. Meghan Lyman: They cannot be distinguished from one another morphologically. CHROMagar can be used to identify the phenotypic differences between the species. Candida albicans can also be distinguished from C auris using the germ tube test.
Dr. Meghan Lyman: Our surveillance shows that 5-10% of colonized individuals have a positive clinical specimen and about half of those are from invasive specimens. But these estimates can vary based on the amount of screening conducted and amount of screening cases detected.
Dr. Meghan Lyman: Mutation in the FKS gene is the most common mutation associated with echinocandin resistance. Echinocandin resistance has been identified among multiple clades, including all three of the major clades circulating in the US.
Dr. Meghan Lyman: Bloodstream infections are the most common cause of invasive infection, but infection of other invasive sites or organs is possible.
Professor of Medicine and Epidemiology
Memorial Hermann Endowed Chair
Vice-Chair of Medicine for Healthcare Quality
Chief, Division of Infectious Diseases
McGovern Medical School
Houston, Texas, USA
Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia, USA
Department of Medicine (Infectious Diseases)
Albert Einstein College of Medicine
Bronx, New York, USA