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Abstract
Candida auris is a fungal pathogen that recently emerged and rapidly spread around the globe. It is now in Canada. C. auris can cause invasive disease with high mortality rates, is frequently resistant to one or more classes of antifungals, and can be difficult to identify in some clinical microbiology laboratories. C. auris can also involve prolonged colonization of patients' skin and contamination of surrounding environments, resulting in nosocomial outbreaks in hospitals and long-term care facilities. Clinicians, infection prevention and control practitioners and public health officials should be aware of how to mitigate the threat posed by this pathogen. Index cases of C. auris should be suspected in patients with invasive candidiasis and recent hospitalization in global regions where C. auris is prevalent, as well as in patients who fail to respond to empiric antifungal therapy and from whom unidentified or unusual Candida species have been isolated. If a case of C. auris infection or colonization is identified or suspected, the following should take place: notification of local public health authorities and infection prevention and control practitioners; placement of colonized or infected patients in single rooms with routine contact precautions; daily and terminal environmental disinfection with a sporicidal agent; contact tracing and screening for C. auris transmission; and referral of suspicious or confirmed isolates to provincial laboratories. Patients with symptomatic disease should be treated with an echinocandin pending the results of antifungal susceptibility testing, preferably in consultation with an infectious disease specialist. Through the vigilance of front-line health care workers and microbiologists, robust infection prevention and control practices, and local and national surveillance efforts, C. auris can be detected quickly, infections managed and transmissions prevented to protect patients in our health care system.
Highlights
In July 2017, the first known case of multidrug-resistant Candida auris was reported in Canada in an individual who had a two-year history of recurrent ear complaints after returning from a trip to India that was marred by hospitalization for a brain abscess following oral surgery [1]
C. auris isolates implicated in healthcare–associated outbreaks have been clonally related, suggesting disease is caused by exogenous strains that are nosocomially spread [5,13,24,25]
C. auris isolates are less susceptible to antifungals than other Candida species, patterns of susceptibility appear to be related to the geographic clade
Summary
In July 2017, the first known case of multidrug-resistant Candida auris was reported in Canada in an individual who had a two-year history of recurrent ear complaints after returning from a trip to India that was marred by hospitalization for a brain abscess following oral surgery [1]. This marked the arrival in Canada of a pathogen that has recently been spreading across the globe. The pathogenesis of candidemia caused by these species typically involves gut translocation of yeasts [21,22]; nosocomial transmission of Candida is occasionally reported, disease is most commonly caused by strains that are part of the patient’s endogenous flora [23]
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