Candida auris and Nosocomial Infection

Author(s): Sweety Dahiya, Anil K. Chhillar*, Namita Sharma, Pooja Choudhary, Aruna Punia, Meenakshi Balhara, Kumar Kaushik, Virinder S. Parmar

Journal Name: Current Drug Targets

Volume 21 , Issue 4 , 2020

  Journal Home
Translate in Chinese
Become EABM
Become Reviewer
Call for Editor

Graphical Abstract:


The existence of the multi-drug resistant (MDR) pathogenic fungus, Candida auris came to light in 2009. This particular organism is capable of causing nosocomial infections in immunecompromised persons. This pathogen is associated with consistent candidemia with high mortality rate and presents a serious global health threat. Whole genome sequence (WGS) investigation detected powerful phylogeographic Candida auris genotypes which are specialized to particular geological areas indicating dissemination of particular genotype among provinces. Furthermore, this organism frequently exhibits multidrug-resistance and displays an unusual sensitivity profile. Identification techniques that are commercialized to test Candida auris often show inconsistent results and this misidentification leads to treatment failure which complicates the management of candidiasis. Till date, Candida auris has been progressively recorded from several countries and therefore its preventive control measures are paramount to interrupt its transmission. In this review, we discussed prevalence, biology, drug-resistance phenomena, virulence factors and management of Candida auris infections.

Keywords: Candida auris, emerging pathogen, multi-drug resistance, candidemia, nosocomial infection.

Arendrup MC, Fuursted K, Gahrn-Hansen B, et al. Seminational surveillance of fungemia in Denmark: notably high rates of fungemia and numbers of isolates with reduced azole susceptibility. J Clin Microbiol 2005; 43(9): 4434-40.
[] [PMID: 16145088]
Brown GD, Denning DW, Gow NAR, Levitz SM, Netea MG, White TC. Hidden killers: human fungal infections. Sci Transl Med 2012; 4(165)165rv13
[] [PMID: 23253612]
Pfaller MA, Diekema DJ. Epidemiology of invasive mycoses in North America. Crit Rev Microbiol 2010; 36(1): 1-53.
[] [PMID: 20088682]
Kullberg BJ, Vasquez J, Mootsikapun P, et al. Efficacy of anidulafungin in 539 patients with invasive candidiasis: a patient-level pooled analysis of six clinical trials. J Antimicrob Chemother 2017; 72(8): 2368-77.
[] [PMID: 28459966]
Rodríguez-Cerdeira C, Arenas R, Moreno Coutiño G, Vásquez E, Fernández R, Chang P, et al. Systemic Fungal Infections in Patients with human inmunodeficiency virus. Actas Dermo- Sifiliográficas (English Edition) 2014; 105: 5-17.
Taur Y, Cohen N, Dubnow S, Paskovaty A, Seo SK. Effect of antifungal therapy timing on mortality in cancer patients with candidemia. Antimicrob Agents Chemother 2010; 54(1): 184-90.
[] [PMID: 19884371]
Sobel JD. The emergence of non-albicans Candida species as causes of invasive candidiasis and candidemia. Curr Infect Dis Rep 2006; 8(6): 427-33.
[] [PMID: 17064635]
Pfaller MA, Andes DR, Diekema DJ, et al. Epidemiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2,496 patients: data from the Prospective Antifungal Therapy (PATH) registry 2004-2008. PLoS One 2014; 9(7)e101510
[] [PMID: 24991967]
Adhikary R, Joshi S. Species distribution and anti-fungal susceptibility of Candidaemia at a multi super-specialty center in Southern India. Indian J Med Microbiol 2011; 29(3): 309-11.
[] [PMID: 21860117]
Papon N, Courdavault V, Clastre M, Bennett RJ. Emerging and emerged pathogenic Candida species: beyond the Candida albicans paradigm. PLoS Pathog 2013; 9(9)e1003550
[] [PMID: 24086128]
Colombo AL, Garnica M, Aranha Camargo LF, et al. Candida glabrata: an emerging pathogen in Brazilian tertiary care hospitals. Med Mycol 2013; 51(1): 38-44.
[] [PMID: 22762208]
Hachem R, Hanna H, Kontoyiannis D, Jiang Y, Raad I. The changing epidemiology of invasive candidiasis: Candida glabrata and Candida krusei as the leading causes of candidemia in hematologic malignancy. Cancer 2008; 112(11): 2493-9.
[] [PMID: 18412153]
Colombo AL, Nucci M, Park BJ, et al. Brazilian Network Candidemia Study. Epidemiology of candidemia in Brazil: a nationwide sentinel surveillance of candidemia in eleven medical centers. J Clin Microbiol 2006; 44(8): 2816-23.
[] [PMID: 16891497]
Centre for disease control and pervantion (CDC). Candida auris Interim Recommendations for Healthcare Facilities and Laboratories| FungalDiseases|CDC. 2018.
Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol 2009; 53(1): 41-4.
[] [PMID: 19161556]
Kim MN, Shin JH, Sung H, et al. Candida haemulonii and closely related species at 5 university hospitals in Korea: identification, antifungal susceptibility, and clinical features. Clin Infect Dis 2009; 48(6): e57-61.
[] [PMID: 19193113]
Sarma S, Kumar N, Sharma S, et al. Candidemia caused by amphotericin B and fluconazole resistant Candida auris. Indian J Med Microbiol 2013; 31(1): 90-1.
[] [PMID: 23508441]
Chowdhary A, Sharma C, Duggal S, et al. New clonal strain of Candida auris, Delhi, India. Emerg Infect Dis 2013; 19(10): 1670-3.
[] [PMID: 24048006]
Magobo RE, Corcoran C, Seetharam S, Govender NP. Candida auris-associated candidemia, South Africa. Emerg Infect Dis 2014; 20(7): 1250-1.
[] [PMID: 24963796]
Emara M, Ahmad S, Khan Z, et al. Candida auris candidemia in Kuwait, 2014. Emerg Infect Dis 2015; 21(6): 1091-2.
[] [PMID: 25989098]
Schelenz S, Hagen F, Rhodes JL, et al. First hospital outbreak of the globally emerging Candida auris in a European hospital. Antimicrob Resist Infect Control 2016; 5: 35.
[] [PMID: 27777756]
Calvo B, Melo AS, Perozo-Mena A, et al. First report of Candida auris in America: Clinical and microbiological aspects of 18 episodes of candidemia. J Infect 2016; 73(4): 369-74.
[] [PMID: 27452195]
Prakash A, Sharma C, Singh A, et al. 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. Clin Microbiol Infect 2016; 22(3): 277.e1-9.
[] [PMID: 26548511]
European Centre for Disease Prevention and Control. Candida auris in healthcare settings, Europe. Stock. ECDC 2016; 19(December): 1-8.
Morales-López SE, Parra-Giraldo CM, Ceballos-Garzón A, et al. Invasive infections with multidrug-resistant yeast Candida auris, Colombia. Emerg Infect Dis 2017; 23(1): 162-4.
[] [PMID: 27983941]
Lockhart SR, Etienne KA, Vallabhaneni S, et al. Simultaneous emergence of multidrug-resistant Candida auris on 3 continents confirmed by whole-genome sequencing and epidemiological analyses. Clin Infect Dis 2017; 64(2): 134-40.
[] [PMID: 27988485]
Ben-Ami R, Berman J, Novikov A, et al. Multidrug-Resistant Candida haemulonii and C. auris, Tel Aviv, Israel. Emerg Infect Dis 2017; 23(1): 195-203.
[] [PMID: 28098529]
Al-Siyabi T, Al Busaidi I, Balkhair A, Al-Muharrmi Z, Al-Salti M, Al’Adawi B. First report of Candida auris in Oman: Clinical and microbiological description of five candidemia cases. J Infect 2017; 75(4): 373-6.
[] [PMID: 28579303]
Ruiz-Gaitán A, Moret AM, Tasias-Pitarch M, et al. An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital. Mycoses 2018; 61(7): 498-505.
[] [PMID: 29655180]
Schwartz IS, Hammond GW. First reported case of multidrug-resistant Candida auris in Canada. Can Commun Dis Rep 2017; 43(7-8): 150-3.
[] [PMID: 29770082]
Kohlenberg A, Struelens MJ, Monnet DL, Plachouras D. The Candida Auris Survey Collaborative G. Candida auris: epidemiological situation, laboratory capacity and preparedness in European Union and European Economic Area countries, 2013 to 2017. Euro Surveill 2018; 23: 18-00136.
Chowdhary A, Sharma C, Meis JF. Candida auris: A rapidly emerging cause of hospital-acquired multidrug-resistant fungal infections globally. PLoS Pathog 2017; 13(5)e1006290
[] [PMID: 28542486]
Khan Z, Ahmad S. Candida auris: an emerging multidrug resistant pathogen of global significance. Curr Med Res Pract 2017; 7: 240-8.
Welsh RM, Bentz ML, Shams A, et al. Survival, persistence, and isolation of the emerging multidrug-resistant pathogenic yeast Candida auris on a plastic health care surface. J Clin Microbiol 2017; 55(10): 2996-3005.
[] [PMID: 28747370]
Chowdhary A, Anil Kumar V, Sharma C, et al. Multidrug-resistant endemic clonal strain of Candida auris in India. Eur J Clin Microbiol Infect Dis 2014; 33(6): 919-26.
[] [PMID: 24357342]
Lee WG, Shin JH, Uh Y, et al. First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol 2011; 49(9): 3139-42.
[] [PMID: 21715586]
Oh BJ, Shin JH, Kim MN, et al. Biofilm formation and genotyping of Candida haemulonii, Candida pseudohaemulonii, and a proposed new species (Candida auris) isolates from Korea. Med Mycol 2011; 49(1): 98-102.
[] [PMID: 20560864]
Mohsin J, Hagen F, Al-Balushi ZAM, et al. The first cases of Candida auris candidaemia in Oman. Mycoses 2017; 60(9): 569-75.
[] [PMID: 28685887]
PAHO WHO (Pan Am Health Organ World Health Organ). “Candida auris” outbreaks in health care services–Epidemiological Alert. 2017.
Ruiz Gaitán AC, Moret A, López Hontangas JL, et al. Nosocomial fungemia by Candida auris: First four reported cases in continental Europe. Rev Iberoam Micol 2017; 34(1): 23-7.
[] [PMID: 28131716]
Barantsevich NE, Orlova OE, Shlyakhto EV, Johnson EM, Woodford N, Lass-Floerl C, et al. Emergence of Candida auris in Russia J Hosp Infect 2019; (19): 30104-5.
Khillan V, Rathore N, Kathuria S, Chowdhary A. A rare case of breakthrough fungal pericarditis due to fluconazole-resistant Candida auris in a patient with chronic liver disease. JMM Case Rep 2014; 1: 1-5.
Kumar D, Banerjee T, Pratap CB, Tilak R. Itraconazole-resistant Candida auris with phospholipase, proteinase and hemolysin activity from a case of vulvovaginitis. J Infect Dev Ctries 2015; 9(4): 435-7.
[] [PMID: 25881537]
Chakrabarti A, Sood P, Rudramurthy SM, et al. Incidence, characteristics and outcome of ICU-acquired candidemia in India. Intensive Care Med 2015; 41(2): 285-95.
[] [PMID: 25510301]
Chawla R, Sud A, Ahmad N, Baveja CP. 2018. Ventriculoperitoneal shunt-associated meningitis caused by candida auris: A Case Report. MAMC J Med Sci 2015; 4: 149-51.
Wang X, Bing J, Zheng Q, et al. The first isolate of Candida auris in China: clinical and biological aspects. Emerg Microbes Infect 2018; 7(1): 93.
[] [PMID: 29777096]
Sarma S, Upadhyay S. Current perspective on emergence, diagnosis and drug resistance in Candida auris. Infect Drug Resist 2017; 10: 155-65.
[] [PMID: 28652784]
Mizusawa M, Miller H, Green R, et al. Can multidrug-resistant Candida auris be reliably identified in clinical microbiology laboratories? J Clin Microbiol 2017; 55(2): 638-40.
[] [PMID: 27881617]
Kathuria S, Singh PK, Sharma C, et al. Multidrug-resistant Candida auris misidentified as Candida haemulonii: characterization by matrix-assisted laser desorption ionization–time of flight mass spectrometry and DNA sequencing and its antifungal susceptibility profile variability by vitek 2, CLSI broth microdilution, andetest method. J Clin Microbiol 2015; 53(6): 1823-30.
[] [PMID: 25809970]
Bentz ML, Sexton DJ, Welsh RM, Litvintseva AP. Phenotypic switching in newly emerged multidrug-resistant pathogen Candida auris. Med Mycol 2018; 0: 1-3.
[PMID: 30329075]
Kordalewska M, Zhao Y, Lockhart SR, Chowdhary A, Berrio I, Perlin DS. Rapid and accurate molecular identification of the emerging multidrug-resistant pathogen Candida auris. J Clin Microbiol 2017; 55(8): 2445-52.
[] [PMID: 28539346]
Muñoz JF, Gade L, Chow NA, et al. Genomic insights into multidrug-resistance, mating and virulence in Candida auris and related emerging species. Nat Commun 2018; 9(1): 5346.
[] [PMID: 30559369]
Tsay S, Welsh RM, Adams EH, et al. MSD. Notes from the field: ongoing transmission of Candida auris in health care facilities—United States, June 2016-May 2017. MMWR Morb Mortal Wkly Rep 2017; 66(19): 514-5.
[] [PMID: 28520710]
Vallabhaneni S, Kallen A, Tsay S, et al. MSD. Investigation of the first seven reported cases of Candida auris, a globally emerging invasive, multidrug-resistant fungus—United States, May 2013-August 2016. MMWR Morb Mortal Wkly Rep 2016; 65(44): 1234-7.
[] [PMID: 27832049]
Sharma C, Kumar N, Pandey R, Meis JFF, Chowdhary A. Whole genome sequencing of emerging multidrug resistant Candida auris isolates in India demonstrates low genetic variation. New Microbes New Infect 2016; 13: 77-82.
[] [PMID: 27617098]
Chatterjee S, Alampalli SV, Nageshan RK, Chettiar ST, Joshi S, Tatu US. Draft genome of a commonly misdiagnosed multidrug resistant pathogen Candida auris. BMC Genomics 2015; 16: 686.
[] [PMID: 26346253]
Sharma C, Kumar N, Meis JF, Pandey R, Chowdhary A. Draft genome sequence of a fluconazole-resistant Candida auris strain from a candidemia patient in India. Genome Announc 2015; 3(4): e00722-15.
[] [PMID: 26184929]
Larkin E, Hager C, Chandra J, et al. The emerging pathogen Candida auris: growth phenotype, virulence factors, activity of antifungals, and effect of SCY-078, a novel glucan synthesis inhibitor, on growth morphology and biofilm formation. Antimicrob Agents Chemother 2017; 61(5): e02396-416.
[] [PMID: 28223375]
Sherry L, Ramage G, Kean R, et al. Biofilm forming capability of highly virulent, multidrug-resistant Candida auris. Emerg Infect Dis 2017; 23(2): 328-31.
[] [PMID: 28098553]
Borman AM, Szekely A, Johnson EM. Comparative pathogenicity of United Kingdom isolates of the emerging pathogen Candida auris and other key pathogenic Candida species. MSphere 2016; 1(4): e00189-216.
[] [PMID: 27547827]
Fakhim H, Vaezi A, Dannaoui E, et al. Comparative virulence of Candida auris with Candida haemulonii, Candida glabrata and Candida albicans in a murine model. Mycoses 2018; 61(6): 377-82.
[] [PMID: 29460345]
Vallabhaneni S, Baggs J, Tsay S, Srinivasan AR, Jernigan JA, Jackson BR. Trends in antifungal use in US hospitals, 2006-12. J Antimicrob Chemother 2018; 73(10): 2867-75.
[] [PMID: 30295769]
Centre for disease control and pervantion (CDC). Candida auris. Clin Update 2017; (September): 2017.
Centre for disease control and pervantion (CDC). Recommendations for Identification of Candida auris. 2017.
Healey KR, Kordalewska M, Jiménez Ortigosa C, et al. Limited ERG11 Mutations Identified in Isolates of Candida auris Directly Contribute to Reduced Azole Susceptibility. Antimicrob Agents Chemother 2018; 62(10): e01427-18.
[] [PMID: 30082281]
Chowdhary A, Prakash A, Sharma C, et al. A multicentre study of antifungal susceptibility patterns among 350 Candida auris isolates (2009-17) in India: role of the ERG11 and FKS1 genes in azole and echinocandin resistance. J Antimicrob Chemother 2018; 73(4): 891-9.
[] [PMID: 29325167]
Whaley SG, Zhang Q, Caudle KE, Rogers PD. Relative Contribution of the ABC Transporters Cdr1, Pdh1, and Snq2 to Azole Resistance in Candida glabrata. Antimicrob Agents Chemother 2018; 62(10): e01070-18.
[] [PMID: 30038038]
Rybak JM, Doorley LA, Nishimoto AT, Barker KS, Palmer GE, Rogersa PD. Abrogation of triazole resistance upon deletion of CDR1 in a clinical isolate of Candida auris. Antimicrob Agents Chemother 2019; AAC.00057-19..
Rhodes J, Abdolrasouli A, Farrer RA, et al. Genomic epidemiology of the UK outbreak of the emerging human fungal pathogen Candida auris. Emerg Microbes Infect 2018; 7(1): 43.
[] [PMID: 29593275]
Vandeputte P, Tronchin G, Larcher G, et al. A nonsense mutation in the ERG6 gene leads to reduced susceptibility to polyenes in a clinical isolate of Candida glabrata. Antimicrob Agents Chemother 2008; 52(10): 3701-9.
[] [PMID: 18694952]
Hull CM, Bader O, Parker JE, et al. Two clinical isolates of Candida glabrata exhibiting reduced sensitivity to amphotericin B both harbor mutations in ERG2. Antimicrob Agents Chemother 2012; 56(12): 6417-21.
[] [PMID: 23027188]
Escando’n P, Chow NA, Caceres DH, Gade L, Berkow EL, Armstrong P, et al. Molecular epidemiology of Candida auris in Colombia reveals a highly-related, country-wide colonization with regional patterns in amphotericin B resistance. Clin Infect Dis 2018; 1-7.
Rudramurthy SM, Chakrabarti A, Paul RA, et al. Candida auris candidaemia in Indian ICUs: analysis of risk factors. J Antimicrob Chemother 2017; 72(6): 1794-801.
[] [PMID: 28333181]
Newnam KM, Harris-Haman P. Noteworthy professional news. Adv Neonatal Care 2017; 17: 233-4.
Azar MM, Turbett SE, Fishman JA, Pierce VM. Donor-Derived transmission of Candida auris during lung transplantation. Clin Infect Dis 2017; 65(6): 1040-2.
[] [PMID: 28520901]
Arendrup MC, Prakash A, Meletiadis J, Sharma C, Chowdhary A. Comparison of EUCAST and CLSI Reference microdilution MICs of eight antifungal compounds for Candida auris and associated tentative epidemiological cutoff values. Antimicrob Agents Chemother 2017; 61(6): e00485-17.
[] [PMID: 28416539]
Centre for disease control and pervantion (CDC). Candida auris interim recommendations for healthcare facilities and laboratories | Fungal diseases | CDC. 2017.
Fakhim H, Chowdhary A, Prakash A, et al. In vitro interactions of echinocandins with triazoles against multidrug-resistant Candida auris. Antimicrob Agents Chemother 2017; 61(11): e01056-117.
[] [PMID: 28848002]
Berkow EL, Angulo D, Lockhart SR. In vitro activity of a novel glucan synthase inhibitor, SCY-078, against clinical isolates of Candida auris. Antimicrob Agents Chemother 2017; 61(7): e00435-17.
[] [PMID: 28483955]
Basso V, Garcia A, Tran DQ, et al. Fungicidal potency and mechanisms of theta-Defensins against multidrug-resistant Candida species. Antimicrob Agents Chemother 2018; 62(6): e00111-8.
[] [PMID: 29610196]
Hager CL, Larkin EL, Long L, Zohra Abidi F, Shaw KJ, Ghannoum MA. In vitro and in vivo evaluation of the antifungal activity of APX001A/APX001 against Candida auris. Antimicrob Agents Chemother 2018; 62(3): e02319-7.
[] [PMID: 29311065]
Berkow EL, Lockhart SR. Activity of CD101, a long-acting echinocandin, against clinical isolates of Candida auris. Diagn Microbiol Infect Dis 2018; 90(3): 196-7.
[] [PMID: 29307565]
Piedrahita CT, Cadnum JL, Jencson AL, Shaikh AA, Ghannoum MA, Donskey CJ. Environmental surfaces in healthcare facilities are a potential source for transmission of Candida auris and other Candida species. Infect Control Hosp Epidemiol 2017; 38(9): 1107-9.
[] [PMID: 28693657]
Escandón P, Cáceres DH, Espinosa-Bode A, et al. Notes from the Field: Surveillance for Candida auris - Colombia, September 2016-May 2017. MMWR Morb Mortal Wkly Rep 2018; 67(15): 459-60.
[] [PMID: 29672473]
Centre for disease control and pervantion (CDC). Isolation precautions | Guidelines library | Infection control | CDC. 2017.
Cadnum JL, Shaikh AA, Piedrahita CT, et al. Effectiveness of disinfectants against Candida auris and other Candida species. Infect Control Hosp Epidemiol 2017; 38(10): 1240-3.
[] [PMID: 28793937]
Lepak AJ, Zhao M, Berkow EL, Lockhart SR, Andes DR. Pharmacodynamic optimization for treatment of invasive Candida auris infection. Antimicrob Agents Chemother 2017; 61(8)e00791
[] [PMID: 28584152]

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2020
Published on: 02 March, 2020
Page: [365 - 373]
Pages: 9
DOI: 10.2174/1389450120666190924155631
Price: $65

Article Metrics

PDF: 21