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| __NOTOC__
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| {{CMG}}{{AE}}{{FB}}
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| ==''Candida auris'' overview|Overview==
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| ''Candida auris'' is a fungus, recently described as a rare cause of fungal infection with significant resistance to [[antifungal medications]].<ref name="pmidPMID 24357342">{{cite journal| author=Chowdhary A, Anil Kumar V, Sharma C, Prakash A, Agarwal K, Babu R et al.| title=Multidrug-resistant endemic clonal strain of Candida auris in India. | journal=Eur J Clin Microbiol Infect Dis | year= 2014 | volume= 33 | issue= 6 | pages= 919-26 | pmid=PMID 24357342 | doi=10.1007/s10096-013-2027-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24357342 }} </ref> It was first described in the year 2009 in Japan,<ref name="pmidPMID 27832049">{{cite journal| author=Vallabhaneni S, Kallen A, Tsay S, Chow N, Welsh R, Kerins J et al.| title=Investigation of the First Seven Reported Cases of Candida auris, a Globally Emerging Invasive, Multidrug-Resistant Fungus - United States, May 2013-August 2016. | journal=MMWR Morb Mortal Wkly Rep | year= 2016 | volume= 65 | issue= 44 | pages= 1234-1237 | pmid=PMID 27832049 | doi=10.15585/mmwr.mm6544e1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27832049 }} </ref> and since then, reports of ''C. auris'' infection has been published from several countries.<ref name="pmidPMID 27832049" /> Serious and prolonged outbreaks have been documented with data showing an innate resilience of ''C.auris'' for survival, persistence in the clinical environment with the ability to rapidly colonize patient's skin, and high transmissibility within the healthcare system.<sup>[[Sandbox:FB|[4]]]</sup> The precise mode of transmission within the healthcare facility is unknown.<ref name="cdc1">Centers for Disease Control and Prevention. https://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-alert.html Accessed on November 11th, 2016. </ref><ref name=cdc2>Public Health England.https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/534174/Guidance_Candida__auris.pdf. Accessed on November 11th, 2016.</ref> The high rate of therapeutic failure noted in cases of ''Candida auris'' fungemia poses significant concerns.<ref name="pmidPMID 24357342" /> Misidentification of ''C.auris'' with related ''[[Candida]]'' species such as ''Candida haemulonii'' by commercially available biochemical-based tests poses a challenge.<ref name="cdc1" /> ''C. auris'' is recognized as a globally emerging fungal pathogen.<ref name="pmidPMID 26548511">{{cite journal| author=Prakash A, Sharma C, Singh A, Kumar Singh P, Kumar A, Hagen F et al.| title=Evidence of genotypic diversity among Candida auris isolates by multilocus sequence typing, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and amplified fragment length polymorphism. | journal=Clin Microbiol Infect | year= 2016 | volume= 22 | issue= 3 | pages= 277.e1-9 | pmid=PMID 26548511 | doi=10.1016/j.cmi.2015.10.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26548511 }} </ref><ref name="pmidPMID 27777756">{{cite journal| author=Schelenz S, Hagen F, Rhodes JL, Abdolrasouli A, Chowdhary A, Hall A et al.| title=First hospital outbreak of the globally emerging Candida auris in a European hospital. | journal=Antimicrob Resist Infect Control | year= 2016 | volume= 5 | issue= | pages= 35 | pmid=PMID 27777756 | doi=10.1186/s13756-016-0132-5 | pmc=5069812 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27777756 }} </ref> Institution of key infection prevention and control measures<ref name="cdc2" /> and, correct identification and standardized antifungal susceptibility testing for optimal management strategies of patients with invasive infections can hardly be overemphasized.<ref name="cdc2" />
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| ==''Candida auris'' historical perspective|Historical Perspective==
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| * ''C. auris'' was first described in 2009 after being isolated from external ear canal discharge of a patient in Japan.<ref name="pmidPMID 27832049" />
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| * ''C. auris'' was incidentally found by molecular identification of bloodstream isolates of unidentified yeasts recovered in 1996, suggesting the paucity of isolation of ''C. auris'' may partly reflect the difficulty in identifying the specie.<ref name="pmid21715586">{{cite journal| author=Lee WG, Shin JH, Uh Y, Kang MG, Kim SH, Park KH et al.| title=First three reported cases of nosocomial fungemia caused by Candida auris. | journal=J Clin Microbiol | year= 2011 | volume= 49 | issue= 9 | pages= 3139-42 | pmid=21715586 | doi=10.1128/JCM.00319-11 | pmc=3165631 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21715586 }} </ref>
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| * The occurrence of ''C. auris'' in nine countries on four continents since 2009 has been reported.<ref name="cdc1" />
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| * ''C. auris'' infections have most commonly been hospital-acquired and occurred several weeks into a patient’s hospital stay.<ref name="cdc1" />
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| * It has been documented to cause infections in patients of all ages.<ref name="cdc1" /><ref name="pmid21715586" /><ref name="pmidPMID 25989098">{{cite journal| author=Emara M, Ahmad S, Khan Z, Joseph L, Al-Obaid I, Purohit P et al.| title=Candida auris candidemia in Kuwait, 2014. | journal=Emerg Infect Dis | year= 2015 | volume= 21 | issue= 6 | pages= 1091-2 | pmid=PMID 25989098 | doi=10.3201/eid2106.150270 | pmc=4451886 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25989098 }} </ref>
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| ==''Candida auris'' pathophysiology|Pathophysiology==
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| * High potential for nosocomial horizontal transmission.<ref name="pmidPMID 27777756" /><ref name="pmidPMID 27452195">{{cite journal| author=Calvo B, Melo AS, Perozo-Mena A, Hernandez M, Francisco EC, Hagen F et al.| title=First report of Candida auris in America: Clinical and microbiological aspects of 18 episodes of candidemia. | journal=J Infect | year= 2016 | volume= 73 | issue= 4 | pages= 369-74 | pmid=PMID 27452195 | doi=10.1016/j.jinf.2016.07.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27452195 }} </ref>
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| * The exact mode of transmission is unknown.<ref name="cdc1" /><ref name="cdc2" />
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| ==''Candida auris'' infection|Infection==
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| * ''C. auris'' is a novel ascomycetous yeast species belonging to the genus ''Candida.''<ref name="pmid19161556">{{cite journal| author=Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H| title=Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. | journal=Microbiol Immunol | year= 2009 | volume= 53 | issue= 1 | pages= 41-4 | pmid=19161556 | doi=10.1111/j.1348-0421.2008.00083.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161556 }} </ref>
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| * It can cause invasive infections, and it is associated with high mortality.<ref name="pmidPMID 27832049" />
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| * ''C. auris'' cases have been identified from clinical sites such as wound swabs, urine samples, vascular devices tips, blood cultures as well as skin screening samples (including nose, oropharynx, axilla, groin and stool samples).<ref name="pmidPMID 27777756" />
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| * ''C. auris'' has been reported to cause bloodstream infections, wound infections, and [[otitis]].<ref name="cdc1" /><ref name="pmid21715586" />
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| * Stay in the Intensive Care Unit has been reported as a major risk factor for ''C. auris'' infection.<ref name="pmidPMID 27777756" />
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| * Patients were found to have similar risk factors for infection with other ''[[Candida]]'' spp.<ref name="cdc1" />
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| * The occurrence of [[candidemia]] attributed to ''C. auris'' appears increasingly common.<ref name="pmidPMID 27777756" />
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| * Evidence of distinct geographic clustering of ''Candida auris'' isolates has been established.<ref name="pmidPMID 26548511" />
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| ==''Candida auris'' differential diagnosis|Differentiating ''Candida auris'' from other ''[[Candida]]'' species==
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| ==''Candida auris'' epidemiology and demographics|Epidemiology and Demographics==
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| ''C. auris'' was first described in 2009 after being isolated from external ear canal discharge of a patient in Japan.<ref name="pmidPMID 27832049" /> Since then, reports of C. auris infections, including bloodstream infections, have been published from several countries, including Colombia, India, Israel, Kenya, Kuwait, Pakistan, South Africa, South Korea, Venezuela, and the United Kingdom.<ref name="pmidPMID 27832049" /> Seven cases have been described in the US.<ref name="pmidPMID 27832049" />
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| Pediatric and adult cases of Candida auris fungemia have been documented.<ref name="cdc1" /><ref name="pmid21715586" /><ref name="pmidPMID 25989098" />
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| ==''Candida auris'' risk factors|Risk factors==
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| ==''Candida auris'' fungemia prognosis|Prognosis==
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| * [[Candidemia]] attributed to ''C auris'' is associated with mortality of up to 50 % in some countries.<ref name="pmidPMID 27777756" />
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| ==Diagnosis==
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| * Currently, reliable methods for speciation are molecular based methods such as PCR, AFLP fingerprinting, sequencing analysis, and MALDI-TOF biotyping.<ref name="pmidPMID 27777756" />
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| * Antifungal susceptibility testing: There are no established minimum inhibitory concentration (MIC) breakpoints at present for C. auris. Using breakpoints for other Candida spp the Centers for Disease Control and Prevention (CDC) demonstrated that of the global outbreaks that they have been investigating, nearly all isolates are highly resistant to fluconazole. In their analysis, more than half of C. auris isolates were resistant to voriconazole, one- third were resistant to amphotericin B (MIC ≥2 mg/L), and a few were resistant to echinocandins. Some isolates have demonstrated elevated MICs to all three major antifungal classes, including azoles, echinocandins, and polyenes indicating that treatment options would be limited. Whole genome sequencing of the organism has found resistant determinants to a variety of antifungal agents.<ref name="cdc2" />
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| ==Treatment==
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| * Candida auris isolates from north and south Indian hospitals, Japan and Korea were all found to be resistant to the antifungal medication fluconazole.<ref name="pmidPMID 24357342" />
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| * Some isolates were also noted to be resistant to antifungal medications such as flucytosine and voriconazole.<ref name="pmidPMID 24357342" />
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| ==Prevention==
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| * isolation of colonised or infected patients with en suite facilities wherever possible.<ref name="cdc2" />
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| * Adherence to strict Infection Prevention and Control precautions, including hand hygiene using soap and water followed by alcohol hand rub, use of personal protective equipment in the form of gloves and aprons (or gowns if there is a high risk of soiling with blood or body fluids).<ref name="cdc2" />
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| * A chlorine releasing agent is currently recommended for cleaning of the environment at 1000 ppm of available chlorine.<ref name="cdc2" />
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| * A terminal clean should be undertaken once the patient has left the environment preferably using hydrogen peroxide vapour. All equipment should be cleaned in accordance with manufacturer’s instructions and where relevant, returned to the company for cleaning. Particular attention should be paid to cleaning of multiple-use equipment (such as BP cuffs, thermometers, computers on wheels, ultra-sound machines) from the bed spaces of infected/colonized patient.<ref name="cdc2" />
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| ==References==
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| {{reflist|2}}
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| {{SI}}
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