Multidrug-resistant Candida auris: not the usual commensal

Abstract

Candidemia remains a public health concern worldwide. In the last 10 years, Candida auris (C. auris) has emerged as a problematic pathogen in the healthcare setting. The pathogen is difficult to identify, multiple-drug-resistant and highly transmissible, and has attracted considerable attention due to its rapid and widespread transmission. The reasons behind the emer-gence of this fungus remain unclear to date. In this review, we discuss the ep-idemiology, clinical manifestations, and pathophysiology of C. auris infection and highlight key factors that enable the fungus to cause outbreaks, includ-ing the difficulties in identification and the ability to colonize medical equipment surfaces, form biofilms, and spread via direct contact, and its re-sistance to anti-fungal agents. As Candida sp. is the fungus most frequently isolated in the mouth, we also assessed whether the oral cavity could be a missing link in the emergence of C. auris outbreaks, and concluded that there is currently scarce evidence supporting the role of oral infections in the spread of this pathogen. Possible explanations include the inability of C. auris to colonise the oral cavity and the significant sensitivity to histatin 5 in hu-man saliva. An understanding of the virulence factors as well as of the mech-anisms that confer protection against C. auris infection, exemplified by the oral ecosystem, may be useful in developing effective anti-fungal strategies for this pathogen.