Molecular Diagnostics in the Times of Surveillance for Candida auris.

Milena Kordalewska,David S Perlin

doi:10.3390/jof5030077

Abstract

Recently, global health professionals have been significantly challenged by the emergence of Candida auris and its propensity to colonize human skin, persist in the healthcare environment, and cause healthcare-associated outbreaks. Additionally, C. auris isolates are often characterized by elevated minimal inhibitory concentration (MIC) values for antifungal drugs. Thus, rapid detection and accurate identification of C. auris together with an assessment of potential antifungal drug resistance has become essential for effective patient management, and infection prevention and control in healthcare facilities. Surprisingly, almost all of the commonly available diagnostic tools rely on recovery (growth) of yeast colonies from collected samples, which delays the diagnostic result by several days or longer. To circumvent these issues, molecular-based DNA amplification assays have been developed to identify C. auris DNA directly from patient samples. Moreover, allele discriminating detection probes can be used to rapidly assess validated mechanisms of echinocandin and azole resistance.

Highlights

Global health professionals have been significantly challenged by the emergence of Candida auris and its propensity to colonize human skin, persist in the healthcare environment, and cause healthcare-associated outbreaks
C. auris isolates are often characterized by elevated minimal inhibitory concentration (MIC) values for antifungal drugs
Rapid detection and accurate identification of C. auris together with an assessment of potential antifungal drug resistance has become essential for effective patient management, and infection prevention and control in healthcare facilities

Summary

Surveillance for Candida auris

Candida auris is an emerging, multidrug-resistant yeast that causes invasive infections, and has been associated with outbreaks in healthcare settings. As we learned by dealing with multidrug-resistant bacteria, early and aggressive approach to control the newly emerged organism is more effective and efficient in controlling transmission than later response to a widespread problem [25,26,27] Seconding this approach, Jackson et al have called for a global response to contain the spread of C. auris infections by developing effective disinfection methods, interventions to reduce patient colonization, rapid tests for detecting patient colonization (to target infection control measures), and broader detection capacity across the globe in clinical laboratories [24]. Rhodes and Fisher underlined the need for the development of global surveillance tools that would facilitate outbreak response [3] All these efforts require local and international collaboration between all involved stakeholders, including healthcare employees (physicians, nurses etc.), infection prevention and control specialists, public health officials, researchers, and industry. We argue that new molecular methods perfectly fill the gaps in C. auris surveillance methodology and can substantially enhance detection capacity and facilitate outbreak response

Standard Processing of Surveillance Samples

Application of Molecular Diagnostics for Surveillance Sample Processing

Antifungal Susceptibility Testing

Molecular Methods

Findings

Conclusions