Candida Auris Infection
What Is It, Causes, Signs, and More
Author:Anna Hernández, MD
Editors:Alyssa Haag,Emily Miao, PharmD,Kelsey LaFayette, DNP, ARNP, FNP-C
Illustrator:Jessica Reynolds, MS
Copyeditor:David G. Walker
What is a Candida auris infection?
Candida auris infection is a globally emerging fungal infection that mainly affects hospitalized individuals and has caused several outbreaks in healthcare facilities. Since its first identification in 2009, C. auris infections have been reported in dozens of countries around the world, including Colombia, India, South Africa, Spain, and the United States.C. auris infections are especially concerning to public health authorities because antifungal medications commonly used to treat other Candida infections are often not effective to treat C. auris. According to the Centers for Disease Control and Prevention (CDC), about 90% of C. auris isolates are resistant to at least one antifungal and around 30% of them are resistant to two antifungals; others are resistant to all three major classes of antifungal medications.
What causes Candida auris infection?
Candida auris infection is caused by a multidrug-resistant fungus of the yeast family called Candida auris. C. auris is spread through contact with contaminated surfaces and equipment as well as from contact with a person who is infected or colonized. Like other Candida species, C. auris can form a biofilm on the skin and other surfaces, which is a jelly-like matrix of proteins where the yeast can live and reproduce. As a result, C. auris can colonize people’s skin without causing infection, allowing it to easily spread to others. In addition, some common healthcare disinfectants are less effective at eliminating it, allowing it to persist in the environment for weeks.
In general, C. auris affects individuals who already have underlying medical conditions and has not been found to cause severe disease in healthy individuals. The main risk factors for acquiring C. auris infection include having a weakened immune system, long-term hospitalizations, recent major surgical procedures, recent use of broad-spectrum antibiotics, and the recent use of indwelling medical devices (e.g., breathing tubes, feeding tubes, urinary catheters, central venous catheters).
What are the signs and symptoms of a Candida auris infection?
Signs and symptoms of Candida auris depend on the part of the body affected. C. auris can cause a wide range of hospital-related (or nosocomial) infections, including bloodstream infections, wound infections, and ear infections among others. The most common nidus of infection is an indwelling medical device, like a central venous catheter or urinary catheter, that is colonized by the fungus. Over time, small clumps of the Candida biofilm can enter the bloodstream and cause severe invasive fungal disease. This complication is characterized by a general feeling of malaise, fever, and chills that do not improve after antibiotic treatment for a suspected bacterial infection.C. auris can cause infections in other locations, such as the urinary tract; heart valves, causing infective endocarditis; bones, resulting in osteomyelitis; or joints, where it can cause septic arthritis. C. auris can also cause meningitis, specifically if present on a device like a ventricular shunt, which is used to drain excess cerebrospinal fluid (CSF). There have also been reports of skin abscesses and wound infections related to the insertion of a catheter or wound drainage device.
How is a Candida auris infection diagnosed?
Candida auris infections are usually diagnosed by culture of the blood or other bodily fluids, such as a urine specimen. C. auris is more challenging to identify than other more common types of Candida and may be misidentified unless specialized laboratory methods are used. Misidentification of the fungus can lead to inappropriate management, making it difficult to control the spread of C. auris in healthcare facilities. Because of its multidrug resistance profile, all C. auris isolates should undergo antifungal susceptibility testing to determine the best treatment option.
How is a Candida auris infection treated?
Candida auris infection is generally treated by a group of antifungal medications called echinocandins (e.g. caspofungin, micafungin, anidulafungin) because most strains of C. auris are often resistant to the other two main antifungal classes (i.e., azoles and polyenes). In severe infections, especially when there is an indwelling medical device infected with a biofilm, it is often necessary to remove the device.Even after treatment for invasive infections, individuals may remain colonized with C. auris for a long time or even indefinitely. Therefore, all recommended infection control measures should be followed during and after treatment for C. auris infection. The main infection prevention and control measures include hand sanitizing, using protective gowns and gloves, cleaning and disinfecting the environment and reusable equipment, and screening contacts of newly identified cases to identify C. auris colonization.
What are the most important facts to know about Candida auris infections?
Candida auris is a multidrug-resistant fungus that causes severe infections in critically ill or hospitalized individuals. Specialized laboratory tests are needed to identify C. auris, as conventional techniques can lead to misidentification of the fungus. C. auris does not respond to commonly used antifungal medications, thereby making it difficult to treat. Treatment generally involves a group of antifungals called echinocandins. Strict infection prevention and control measures are needed to prevent C. auris spreading in healthcare facilities.
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Resources for research and reference
Antifungal susceptibility testing and interpretation. (2020). In Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/fungal/candida-auris/c-auris-antifungal.html
Cortegiani, A., Misseri, G., Fasciana, T., Giammanco, A., Giarratano, A., & Chowdhary, A. (2018). Epidemiology, clinical characteristics, resistance, and treatment of infections by Candida auris. Journal of Intensive Care, 6(1). DOI: 10.1186/s40560-018-0342-4
Horton, M. V., & Nett, J. E. (2020). Candida auris infection and biofilm formation: Going beyond the surface. Current Clinical Microbiology Reports, 7(3): 51–56. DOI: 10.1007/s40588-020-00143-7
Infection Prevention and Control for Candida auris. (2023, April 5). In Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/fungal/candida-auris/c-auris-infection-control.htmlPappas, P. G., Kauffman, C. A., Andes, D. R., Clancy, C. J., Marr, K. A., Ostrosky-Zeichner, L., … & Sobel, J. D. (2015). Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 62(4). DOI: 10.1093/cid/civ933