Multidrug-Resistant Candida Auris: Need for Alert among Microbiologists

Abstract

Candida auris is recognised as a newly emerging species that was first identified in 2009 from the ear canal of a patient in Japan. C. auris soon became important cause of bloodstream infection in other parts of Asia and the last 8 years has emerged on other continents i.e., Africa, South America and in North America and Europe. The emergence of C. auris in India was noted in sporadic outbreaks and a multicentric study of candidemia among Intensive Care Units in 2011.[1‑4] This fungus is posing significant challenges to microbiologists and clinicians as (i) antifungal resistance is the norm rather than the exception, (ii) easily transmitted from person to person in a health‑care setting and (iii) misidentification by standard biochemical identification systems primarily due to lack of C. auris in their databases and is mainly misidentified as Candida haemulonii by Vitek‑2. Currently, accurate identification is through matrix‑assisted laser desorption ionization time‑of‑flight mass spectrometry and sequencing. Universally, C. auris show high resistance to fluconazole and to lesser extent to amphotericin B and echinocandin. Falsely elevated MICs of amphotericin B and caspofungin are reported by Vitek 2.[5] Whole genome sequencing (WGS) of isolates from different countries support its simultaneous emergence worldwide rather than spread from one place to another. WGS of Indian isolates showed clonal origin suggesting nosocomial transmission. C. auris‑specific infection control measures such as single room, contact precautions, hand hygiene and disinfection with an EPA‑approved agent are recommended. The rampant threat by multidrug‑resistant strains of C. auris had prompted CDC and Public Health England release clinical alerts, followed by the European Centres for Disease Control. Under the aegis of Antimicrobial resistance network, ICMR has recently issued an advisory note (http://www.icmr.nic. in/icmrnews/candida%20auris.pdf) on C. auris emphasising the need for active surveillance of this yeast among Indian hospitals and to assist with the identification and antifungal susceptibility of C. auris.