Candida auris infection

Causative agent

Candida auris (C. auris) is an emerging multidrug-resistant fungus that first discovered and isolated from the external ear canal of a patient in Japan in 2009. Most C. auris infections are healthcare-associated. While C. auris can colonise patients without causing symptoms for many months and persist in the environment, it can cause severe infections leading to death. C. auris presents a serious global public health threat because (1) it is often multidrug-resistant; (2) it is difficult to identify with standard laboratory methods, and it can be misidentified which in turn may lead to inappropriate management; and (3) it has caused outbreaks in healthcare facilities, including hospitals and nursing homes.

Clinical features

C. auris has been found in noninvasive body sites and can colonize a person without causing active infection. These sites include skin like armpit and groin, nostrils, external ear canal, wounds, urine, and respiratory specimens. On the other hand, it can cause disease including intra-abdominal, wound, ear and bloodstream infections which can turn out to be severe or fatal.

Identified risk factors for C. auris infection include administration of antibacterial and antifungal agents, vascular and abdominal surgery, the presence of invasive medical devices (such as central venous catheters, post-operative drains and urinary catheters), immunosuppression, chronic renal disease, haemodialysis, diabetes mellitus and prolonged ICU admission.

Mode of transmission

The main mode of transmission of C. auris is through direct contact with affected patients, or indirect contact with contaminated environmental surfaces or equipment, or from person to person in healthcare and long-stayed facilities.

Management

Doctors may prescribe appropriate antifungal treatment for symptomatic cases with reference to the laboratory results. Most cases can be treated with a class of antifungal drugs called echinocandins. However, some C. auris infections are resistant to all three main classes of antifungal medication. High dose of multiple antifungals may be required for treatment. Skin lesions such as boils or abscesses may require incision and drainage.

Prevention

Implement the following measures to prevent and control the transmission of C. auris:

◇ Maintain good personal hygiene, especially keep hands clean.

• Perform hand hygiene frequently, especially before touching the mouth, nose or eyes; after touching public installations such as handrails or door knobs; or when hands are contaminated by respiratory secretion after coughing or sneezing.
• Wash hands with liquid soap and water, and rub for at least 20 seconds. Then rinse with water and dry with a disposable paper towel or hand dryer. If hand washing facilities are not available, or when hands are not visibly soiled, hand hygiene with 70 to 80% alcohol-based handrub is an effective alternative.

◇ Avoid sharing of personal items such as towels, clothing, razor or nail clippers.

◇ Avoid direct contact with excreta, wounds, secretions or contaminated objects with bare hands. Wear appropriate personal protective equipment (e.g. gloves) whenever it is necessary to handle them. Wash hands thoroughly with liquid soap and water afterwards.

◇ If there are abrasions or cuts, cover them properly with waterproof adhesive dressings until healed, and avoid visiting public bathrooms, massage parlors or spa.

◇ Maintain environmental hygiene and items cleanliness. For example, regularly disinfect furniture and facilities by using 1 in 49 diluted household bleach (i.e., adding one part of household bleach containing 5.25% sodium hypochlorite to 49 parts of water). Use 70% alcohol to disinfect metal surfaces.

◇ Seek medical advice promptly if signs or symptoms of infection develop.

◇ Follow prescriptions by doctors and use antimicrobials properly.

• Do not demand antimicrobials from your doctor.
• Follow your doctor’s advice when taking antimicrobials.
• Do not stop taking antimicrobials by yourselves even if you are feeling better.
• Do not take leftover antimicrobials.
• Do not share your antimicrobials with others.

For caring of C. auris carriers in community institutions like Residential Care Homes for Elderlies and Residential Care Homes for Persons with Disability, to prevent further spread, the following key elements should be noted: