Candida auris, an Agent of Hospital-Associated Outbreaks: Which Challenging Issues Do We Need to Have in Mind?

Abstract

The emergence of Candida auris is considered as one of the most serious problems associated with nosocomial transmission and with infection control practices in hospital environment. This multidrug resistant species is rapidly spreading worldwide, with several described outbreaks. Until now, this species has been isolated from different hospital surfaces, where it can survive for long periods. There are multiple unanswered questions regarding C. auris, such as prevalence in population, environmental contamination, effectiveness of infection prevention and control, and impact on patient mortality. In order to understand how it spreads and discover possible reservoirs, it is essential to know the ecology, natural environment, and distribution of this species. It is also important to explore possible reasons to this recent emergence, namely the environmental presence of azoles or the possible effect of climate change on this sudden emergence. This review aims to discuss some of the most challenging issues that we need to have in mind in the management of C. auris and to raise the awareness to its presence in specific indoor environments as hospital settings.

Keywords: Candida auris; azole resistance; environmental contamination; horizontal transmission; hospital infection.

Figure 1

Global epidemiology of Candida auris for November 2019 (image adapted from CDC [19]). Single cases were reported from Austria, Belgium, Chile, Italy, Greece, Egypt, Iran, Norway, Switzerland, Taiwan and United Arab Emirates. Multiple cases and extensive hospital transmission were reported from Australia, Bangladesh, Canada, China, Colombia, France, Germany, India, Israel, Japan, Kenya, Kuwait, Malaysia, Paskistan, Netherlands, Oman, Panama, Russia, Saudi Arabia, Singapore, South Africa, South Korea, Spain, UK, USA and Venezuela [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35].