Abstract
From 2009, Candida auris has emerged as a multidrug‐resistant ascomycete yeast pathogen with the capacity for easy transmission between patients and hospitals, as well as persistence on environmental surfaces. Its association with high mortalities, breakthrough and persistent candidaemia, inconsistencies in susceptibility testing results, misidentification by available commercial identification systems and treatment failure, complicates its management and detection. Within the last nine years, C. auris has been increasingly reported from far‐Eastern Asia, the Middle East, Africa, Europe, South and North America with substantial fatalities and misidentification. Herein, I provide a systematic and thorough review of this emerging pathogen. Meta‐analysis showed that at least 742 C. auris isolates have been reported in 16 countries, with most of these being from India (≥243), USA (≥232) and UK (≥103) (p‐value = .0355) within 2013–2017. Most isolates were from males (64.76%) (p‐value = .0329) and blood (67.48%) (p‐value < .0001), with substantial crude mortality (29.75%) (p‐value = .0488). Affected patients presented with other comorbidities: diabetes (≥52), sepsis (≥48), lung diseases (≥39), kidney diseases (≥32) etc. (p‐value < .0001). Resistance to fluconazole (44.29%), amphotericin B (15.46%), voriconazole (12.67%), caspofungin (3.48%) etc. were common (p‐value = .0059). Commonly used diagnostic tools included PCR (30.38%), Bruker MALDI‐TOF MS (14.00%), Vitek 2 YST ID (11.93%), AFLP (11.55%) and WGS (10.04%) (p‐value = .002). Multidrug resistance, high attributable mortality and persistence are associated with C. auris infections. Two novel drugs, SCY‐078 and VT‐1598, are currently in the pipeline. Contact precautions, strict infection control, periodic surveillance and cleaning with chlorine‐based detergents, efficient, faster and cheaper detection tools are necessary for prevention, containment and early diagnosis of C. auris infections.
Highlights
Antimicrobial resistance (AMR) is inarguably one of the greatest threats and challenges to clinical medicine and public health in this century (Laxminarayan et al, 2016)
AMR was mainly reported in bacteria
Sherry et al (2017) showed that C. auris biofilms, just like that of other species of Candida, were resistant to CFG and MCF (MIC > 32 mg/L), to FLZ (MIC > 32 mg/L), to VRZ, and amphotericin B (AMB) (MIC > 4 mg/L); only liposomal AMB was effective in limiting growth at a lower concentration (MIC = 0.25–1 mg/L), albeit up to 16 mg/L was necessary to stop biofilm metabolic activity by 90% (Sherry et al, 2017)
Summary
Antimicrobial resistance (AMR) is inarguably one of the greatest threats and challenges to clinical medicine and public health in this century (Laxminarayan et al, 2016).
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