Update on Candida Auris

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Candida auris fungus is frequently a multidrug-resistant organism that causes serious, often deadly infections.  I first became aware of it about a year ago and published information on the website labtestingmatters.org.  C. auris was originally identified in Japan in 2009 and subsequently became identified in more than 20 countries around the globe including the United States. 


A year ago I indicated that approximately 150 infections had been identified in the US, predominantly in hospitals and nursing homes.  Today that number is greater than 600 US infections with greater than 300 identified in New York State and the majority of those cases in approximately 50% of the hospitals in New York City.  There are several major considerations you should keep in mind about C. auris:   

  1. C. auris can cause sepsis and other types of invasive infections. The infections are most common in patients with multiple medical problems who are hospitalized or residing nursing homes.  The mortality rate can reach as high as 60%.
  2. C. auris can be difficult to identify and misidentification may lead to inappropriate management. Unrecognized, C. auris can lead to spread of infection to other patients in a given facility. The most reliable way to identify C. auris is matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS).  Some molecular methods will also accurately identify the organism.  In instances where these technologies are not available for Candida speciation, the State Health Department or CDC need to be contacted to provide assistance.
  3. As it can cause significant outbreaks in health care settings, identification and microbial resistance determination must be performed rapidly so that appropriate isolation procedures can be instituted to avert the nosocomial spread of infection.
  4. The majority of infections respond to the class of antifungal medications known as echinocandins, but some strains resist all three main classes of drugs used to treat Candida infection.
  5. C. auris can cause colonization of surfaces for a period of weeks to months and can be quite difficult to eradicate. Some patients and care givers have been documented to have skin colonization for over a year.  It rapidly and readily colonizes infected patient rooms.  It has been identified on surfaces of all types from windowsills to patient care machines to care deliverer shoes even after the patient is gone and the room and staff have received decontamination.  In a London hospital, 70 patients were infected with the organism believed to have been spread by hospital thermometers.  Bleach works well to eradicate the organism, but obviously, this cannot be used on every surface and instrument.  FDA approved and CDC recommended disinfectants are available to assist in the prevention of contamination and subsequent nosocomial infection.

I bring this topic to the fore again because Candida is a not uncommon blood stream infection and it is important to rapidly speciate the Candida when it is identified.  Because many facilities lack the ability to speciate Candida auris, it is essential to reach out to your state public health laboratory for assistance to assure expeditious Candida species identity and prevent Candida auris from becoming a major nosocomial problem throughout your facility and ultimately the country.

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Dr. John Daly

John T. Daly, M.D. received his MD degree at Weill Cornell University Medical College, performed his internship and residency in Anatomic and Clinical pathology at Duke University Medical Center and a residency in Forensic Pathology at the Office of the Chief Medical Examiner in Chapel Hill, N.C. He is board certified in anatomic, clinical and forensic pathology. Through the course of his career, Dr. Daly has had extensive experience directing and advising laboratories of all sizes including physician office practices, Federal Health Clinics, surgical centers, Community Hospitals and the integrated academic health system clinical laboratories of Duke Medicine. He retired as Director of Laboratories of Duke Medicine, and continues his affiliation as a member of the emeritus staff.


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