LITERATURE UPDATE
to cause outbreaks in healthcare settings, especially in nursing homes for elderly patients, owing to its efficient transmission via skin-to-skin contact. Most importantly, C. auris is the first fungal pathogen to show pronounced and sometimes untreatable clinical drug resistance to all known antifungal classes, including azoles, amphotericin B, and echinocandins. In this review, the authors explore the causes of the rapid spread of C. auris. They also highlight its genome organisation and drug resistance mechanisms, and propose future research directions that should be undertaken to curb the spread of this multidrug-resistant pathogen.
Candida auris as an emergent public health problem: a current update on European outbreaks and cases Geremia N, Brugnaro P, Solinas M, Scarparo C, Panese S. Healthcare (Basel). 2023 Feb 2; 11 (3): 425. doi: 10.3390/ healthcare11030425.
Candida auris is considered to be an emerging fungal pathogen and is related to high mortality rates, persistent candidemia, inconsistencies in susceptibility testing results and misidentification by available commercial identification systems. Multidrug-resistant (MDR) and pandrug-resistant (PDR) strains are increasingly detected. In Europe, hospital outbreaks caused by C. auris have been reported in the UK, Italy and Spain; however, several cases have been sporadically detected in all European countries. C. auris is difficult to control despite enhanced control measures due to its ability to survive for a long time in environments and colonise patients for prolonged periods. An adequate laboratory diagnostic capacity and national surveillance are fundamental to rapidly detect new C. auris cases and to apply the correct measures to circumscribe them and prevent their spread. This narrative review aims to highlight the primary C. auris outbreaks and case reports that have occurred in Europe.
Worsening spread of Candida auris in the United States, 2019 to 2021 Lyman M, Forsberg K, Sexton DJ et al. Ann Intern Med. 2023 Apr; 176 (4): 489–95. doi: 10.7326/M22-3469.
Candida auris is an emerging fungal threat that has been spreading in the United States since it was first reported in 2016. This study describes recent
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changes in the US epidemiology of C. auris occurring from 2019 to 2021. Case counts reported to the Centers for Disease Control and Prevention by health departments, volume of colonisation screening, and antifungal susceptibility results were aggregated and compared over time and by geographic region.
A total of 3270 clinical cases and
7413 screening cases of C. auris were reported in the United States through 31 December 2021. The percentage increase in clinical cases grew each year, from a 44% increase in 2019 to a 95% increase in 2021. Colonisation screening volume and screening cases increased in 2021 by more than 80% and more than 200%, respectively. From 2019 to 2021, 17 states identified their first C. auris case. The number of cases that were resistant to echinocandins in 2021 was about three times that in each of the previous two years.
Identification of screening cases depends on screening that is done on the basis of need and available resources. Screening is not conducted uniformly across the United States, so the true burden of C. auris cases may be underestimated. C. auris cases and transmission have
risen in recent years, with a dramatic increase in 2021. The rise in echinocandin- resistant cases and evidence of transmission is particularly concerning because echinocandins are first-line therapy for invasive Candida infections, including C. auris.
These findings highlight the need for
improved detection and infection control practices to prevent spread of C. auris.
Climate change, animals, and Candida auris: insights into the ecological niche of a new species from a One Health approach Garcia-Bustos V, Cabañero-Navalon MD, Ruiz-Gaitán A, Salavert M, Tormo-Mas MÁ, Pemán J. Clin Microbiol Infect. 2023 Jul; 29 (7): 858–62. doi: 10.1016/j. cmi.2023.03.016.
One of the most puzzling traits of Candida auris is the recent simultaneous and independent emergence of five genetically distinct clades on three continents. Global warming has been proposed as a contributing factor for this emergence due to high thermotolerance of C. auris compared with phylogenetically close Candida species. This hypothesis postulates that climate change induced an environmental ancestor to become pathogenic through thermal adaptation and was then globally disseminated by an intermediate host.
The aim of this review is to compile
the current knowledge on the emergence and ecological environmental niches of C. auris and highlight the potential role of animals in transmission. A literature search was conducted using PubMed, MEDLINE, Google Scholar, and Web of Science from May 2022 to January 2023.
The authors discuss the up-to-date data on the ecological niches of this fungus and its mechanisms of emergence, transmission cycle in nature, and worldwide dissemination. They highlight the possibility of an originally intermediate host possibly related to marine or freshwater ecosystems on the basis of recent molecular and microbiological evidence from a One Health perspective. The consequences of harmful human impact on the environment in the rise of new fungal pathogenic species, such as C. auris, are also analysed and compared with other animal precedents. The present knowledge can prompt the generation of new evidence on the ecological reservoirs of C. auris and its original mechanisms of environmental or interspecies transmission. Further research on the highlighted gaps will help to understand the importance of the relationships between human, animal and ecosystem health as factors involved in the rise and spread of emerging fungal pathogenic species.
High-throughput profiling of Candida auris isolates reveals clade-specific metabolic differences Brandt P, Mirhakkak MH, Wagner L et al. Microbiol Spectr. 2023 Jun 15; 11 (3): e0049823. doi: 10.1128/ spectrum.00498-23.
Candida auris, a multidrug-resistant human fungal pathogen that causes outbreaks of invasive infections, emerged as four distinct geographical clades. Previous studies identified genomic and proteomic differences in nutrient utilisation on comparison to Candida albicans, suggesting that certain metabolic features may contribute to C. auris emergence. As no high-throughput clade-specific metabolic characterisation has been described yet, the authors performed a phenotypic screening of C. auris strains from all four clades on 664 nutrients, 120 chemicals, and 24 stressors. They identified common and clade- or strain-specific responses, including the preferred utilisation of various dipeptides as nitrogen source and the inability of the clade II isolate AR 0381 to withstand chemical stress.
Further analysis of the metabolic FEBRUARY 2024
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