Candida auris: The First Resistant Candida

Abstract

Candida  auris has recently emerged as a multidrug-resistant causative agent of blood-

stream and invasive nosocomial  infections.  With most resistant to fluconazole (empiric treatment for candidemia), resistance to two or more antifungal drug classes especially amphotericin B (major drug used for treatment for rare yeast species), and echinocandins (recently developed for treatment Candida infection) deter the effective treatment with high rate of mortality. Unlike C. albicans  and other Candida  species, once a case of  C.  auris  has occurred, the yeast may colonize  on the human body for several weeks. It has high potential of transmission to other patients and surrounding environments, then, causing a nosocomial  infection  outbreak. Thus, early detection in the healthcare service is a key importance not only for providing the most suitable for patient management but also for prompt management of infection prevention and control (IPC). Report cases in many continents and hospital outbreak with supportive evidences of transmission among patients and environment have alert global healthcare settings to perform surveillance using an accurate identification  by sequencing  (ITS or D1/D2)  or MALDI-TOF MS as recommended by the US CDC and other health authorities. Uncareful identification,  C. auris is often misidentified as C. haemulonii  as well as other species of Candida.  Although, no case has been reported yet in Thailand, a watchdog system is required to avoid unwanted dissemina- tion and outbreak of nosocomial  C. auris  infection. We are facing an emerging novel patho- genic yeast (rare yeast species) with aggressive multidrug resistance to antifungals. Therefore, it is the time to revise and maximize the laboratory method of identification to assure accurate results from the clinical laboratories. In this review, we hightlight the incidence, characteristics, pitfall identification, as well as antifungal resistance of C. auris.