The lurking scourge of multidrug resistant Candida auris in times of COVID-19 pandemic

Abstract

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019 has caused a pandemic of COVID-19. A particularly disturbing feature of COVID-19 patients is their tendency to develop acute respiratory distress syndrome that requires ICU admission, mechanical ventilation and/or extracorporeal membrane oxygenation [1]. Reports from several countries suggest flooding of hospital ICUs by COVID-19 patients that require respiratory support ranging from high-flow nasal cannula to invasive ventilation. This haunting facet of COVID-19 pandemic has severely challenged even the most advanced hospital settings. Yet one potential confounder, not in the immediate attention of most healthcare professionals, is the secondary transmission of multidrug resistant organisms like the fungus Candida auris in COVID-19 ICUs [2]. Before the arrival of SARS-CoV-2, C. auris was considered a major global health threat due to high rates of drug resistance and ease of transmission in hospital settings. Indeed, multidrug resistant C. auris has been reported from over 40 countries across six continents since its first description a decade ago. Given the nosocomial transmission of SARS-CoV-2 by those infected, many hospital environments may serve as venues for C. auris transmission as it is a known environmental colonizer of ICUs. C. auris patients shed viable yeast cells from their skin continuously and thereby contaminate hospital environments. C. auris outbreaks occur in critically ill hospitalized patients and can result in mortalities rates ranging from 30% to 72% [3]. Both C. auris and SARS-CoV-2 have been found on hospital surfaces including on bedrails, IV poles, beds, air conditioner ducts, windows and hospital floors [4], [5]. Therefore, the standard COVID-19 critical care of mechanical ventilation and protracted ventilator-assisted management makes these patients potentially susceptible to colonization and infections by C. auris.