Candida auris: A systematic review and meta-analysis of current updates on an emerging multidrug-resistant pathogen

Abstract

From 2009, Candida auris has emerged as a multidrug-resistant ascomycete yeast pathogen with the capacity for easy transmission between patients and hospitals, as well as persistence on environmental surfaces. Its association with high mortalities, breakthrough and persistent candidaemia, inconsistencies in susceptibility testing results, misidentification by available commercial identification systems and treatment failure, complicates its management and detection. Within the last nine years, C. auris has been increasingly reported from far-Eastern Asia, the Middle East, Africa, Europe, South and North America with substantial fatalities and misidentification. Herein, I provide a systematic and thorough review of this emerging pathogen. Meta-analysis showed that at least 742 C. auris isolates have been reported in 16 countries, with most of these being from India (≥243), USA (≥232) and UK (≥103) (p-value = .0355) within 2013-2017. Most isolates were from males (64.76%) (p-value = .0329) and blood (67.48%) (p-value < .0001), with substantial crude mortality (29.75%) (p-value = .0488). Affected patients presented with other comorbidities: diabetes (≥52), sepsis (≥48), lung diseases (≥39), kidney diseases (≥32) etc. (p-value < .0001). Resistance to fluconazole (44.29%), amphotericin B (15.46%), voriconazole (12.67%), caspofungin (3.48%) etc. were common (p-value = .0059). Commonly used diagnostic tools included PCR (30.38%), Bruker MALDI-TOF MS (14.00%), Vitek 2 YST ID (11.93%), AFLP (11.55%) and WGS (10.04%) (p-value = .002). Multidrug resistance, high attributable mortality and persistence are associated with C. auris infections. Two novel drugs, SCY-078 and VT-1598, are currently in the pipeline. Contact precautions, strict infection control, periodic surveillance and cleaning with chlorine-based detergents, efficient, faster and cheaper detection tools are necessary for prevention, containment and early diagnosis of C. auris infections.

Keywords: Candida auris; antifungal resistance; candidaemia; fungemia; molecular epidemiology.

Figure 1

PRISMA‐adapted flow diagram of included and excluded studies. Adapted from the PRISMA website (http://prisma-statement.org/PRISMAStatement/CitingAndUsingPRISMA.aspx) and article

Figure 2

Frequency of Candida auris isolated per country between 1996 and 2007 (a), comorbidities presented by C. auris‐infected patients (b) and crude mortality rates per country (c). Total number of reported isolates, comorbities, and mortalities per study were collated per country and used to calculate the frequencies. GraphPad was used to calculate the p‐values

Figure 3

Frequency of males and females infected with Candida auris per country (a), specimen sources (b), and antifungal resistance rates (c). Total number of reported cases per male and female patients, specimen sources and antifungal resistance per study were collated per country and used to calculate the frequencies. GraphPad was used to calculate the p‐values

Figure 4

Scanning electron micrograph of Candida auris treated with no drug (control) (a) and with SCY‐078 at 1 × MIC (0.5 mg/L) (b). Adapted with permission from Emily Larkin et al. Antimicrob. Agents Chemother. 2017; 61:e02396–16