Candida auris: The First Resistant Candida
Candida auris has recently emerged as a multidrug-resistant causative agent of bloodstream 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. UnlikeC. 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 dissemination and outbreak of nosocomial C. auris infection. We are facing an emerging novel pathogenic 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.
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