Candida Auris: What You Need To Know
The Candida auris is the name given to the fungus of the candid family. It has become infamous in the scientific community for its ability to develop resistance to antifungals often used in clinical practice.
Outbreaks caused by this fungus have almost always broken out in hospitals or nursing homes for the elderly. Furthermore, they were of alarming severity, to the point of leading to septicemia, or the spread of the infection through the patient’s blood.
The organism was first isolated in 2009. It received the name auris because it was isolated from a sample of the ear canal of a patient from South Korea. Later, more outbreaks of this type of candida erupted in hospitals. caused a state of alert in 2016 and 2017.
The most serious outbreaks were recorded in the intensive care units. This has led to the stiffening of precautionary measures among health personnel in order to curb the contagion; however, the mushroom’s resilience was a further problem.
Given its ability to survive in hospital settings, its resistance to the drug is believed to be remarkable. Samples taken from hospital floors, furniture placed in hospital rooms, and even healthcare staff computers have tested positive for Candida auris.
The cases of Candida auris in the world
Following the confirmation of the first case of Candida auris in 2009, the researchers admitted that previous unidentified infections may have been caused by this pathogen. One case in particular raised suspicion, involving a South Korean citizen in 2008.
Right from that moment, with the scientific knowledge acquired, cases were then identified in India, South Africa, Venezuela, the United Kingdom, Israel and the United States. These last two countries, together with Spain and Colombia, recorded some in 2016, a year that saw the presence of several outbreaks.
As for the inpatient cases, two are significant. The first occurred at London’s Royal Brompton hospital in 2015, the other at Valencia’s La Fe hospital in 2016. Both outbreaks affected a considerable number of inpatients.
Risk factors
Not all patients exposed to Candida auris become infected and experience severe symptoms. There are known cases of healthy carriers of the fungus who do not develop symptoms. This situation is known as colonization and, although it is not serious for the bearer, the subject is potentially contagious to others.
The main risk factor for infection is being hospitalized and undergoing an invasive instrument, be it a tube or catheter. Other risk factors are:
- Admission to a nursing home for the elderly
- Frequently undergo courses of antifungals
- Go to the hospital frequently, both for personal health problems and as a visitor to an inpatient patient
The resistance of Candida auris to drugs
A surprising feature of Candida auris is its resistance to antifungal drugs, an aspect that is of great concern to epidemiologists and infectious disease specialists. The hospital outbreaks raise alarm because, at least at first, it is not known how difficult it will be to eradicate the fungus that has spread.
Almost all variants of Candida are sensitive to fluconazole. For example, Candida albicans infections are often treated with this drug. Well, in the case of Candida auris , resistance to fluconazole is immediate.
Additional forms of resistance to other antifungals have been recorded, including those to amphotericin B and voriconazole. According to scientific tests, about 90% of registered Candida auris strains are resistant to a class of antifungals, while a third of these resist more than two different drugs.
Treatment
At present, one group of antifungals in particular has shown relative effectiveness in eliminating Candida auris . These drugs are echinocandins, and the best known are three: anidulafungin, caspofungin and micafungin.
However, these medicines are not always available and there have been reports of strains resistant to the latter as well. Should this situation arise, the protocol proposes the administration to the infected patient of a mixture of antibiotics at higher doses than usual.
We also agree that these patients already suffer from a disease that required hospitalization. As a result, their immune systems are weakened and other pathologies coexist. The medical team in charge will have to define the ways of combining drugs according to the case.
The criticality of the situation reminds us how important it is to be cautious when taking drugs. Both patients and physicians must follow prescribed guidelines to prevent microbial resistance from developing.
