Candida auris

Candida auris is a more recent arrival, first described in Japan 2009, emerging in clinical settings around the globe, seemingly simultaneous, from the Candida clade of genetically similar yeasts. While this species has been less common to recover in clinical specimens than other species of Candida (i.e. C. albicans and C. glabrata), C. auris has been very rapidly gaining multi-drug resistance in clinical settings over the past decade. Due to the species niche preferences, C. auris is a common commensal organism on human skin.

Candida auris is classified into four genetic clades (I–IV). Clade II, predominantly isolated in Japan, is associated with non-invasive cases, whereas clades I, III, and IV are linked to invasive infections. Systemic infections, including bloodstream infections, have a reported mortality rate of 30–60%. While typically asymptomatic in healthy individuals, colonization can persist on the skin for over a month.

Relevance of pathogen in transmission in endoscopy

• Gastroenterology: Low

• Pulmonology: High

• Ear, nose, and throat: High

• Urology: High

Relevance for endoscope surveillance

• High concern organism, possibly indicative of lapses in endoscope reprocessing and rarely linked to water quality

Transmission route

Candida auris can be transmitted through direct contact with contaminated individuals, such as hand-to-hand contact, or indirect contact with contaminated surfaces, medical equipment, or objects in the surrounding environment. Since it has the potential to persist in hospital environments for extended periods, it is also crucial to perform thorough terminal cleaning and disinfection of patient rooms after the discharge of infected or colonized individuals.

Resistance to antifungals

Compared to other Candida species, Candida auris exhibits significantly higher resistance rates to antifungal agents. In studies investigating the antifungal susceptibility of isolates from multiple countries, 93% of isolates were found to be resistant to fluconazole, 35% were resistant to amphotericin B, and 41% showed resistance to at least two classes of antifungal agents. Furthermore, isolates resistant to all three major classes of antifungal drugs have also been identified.