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Introduction For decades, clinicians dealing with immunocompromised and critically ill patients have perceived a link between Candida colonization and subsequent infection. However, the pathophysiological progression from colonization to infection was clearly established only through the formal description of the colonization index (CI) in critically ill patients. Unfortunately, the literature reflects intense confusion about the pathophysiology of invasive candidiasis and specific associated risk factors. Methods We review the contribution of the CI in the field of Candida infection and its development in the 20 years following its original description in 1994. The development of the CI enabled an improved understanding of the pathogenesis of invasive candidiasis and the use of targeted empirical antifungal therapy in subgroups of patients at increased risk for infection. Results The recognition of specific characteristics among underlying conditions, such as neutropenia, solid organ transplantation, and surgical and nonsurgical critical illness, has enabled the description of distinct epidemiological patterns in the development of invasive candidiasis. Conclusions Despite its limited bedside practicality and before confirmation of potentially more accurate predictors, such as specific biomarkers, the CI remains an important way to characterize the dynamics of colonization, which increases early in patients who develop invasive candidiasis.

Candida auris is an emerging infectious agent with limited antimicrobial susceptibilities. An outbreak was identified in a neurosciences ICU in the United Kingdom and was linked to reusable temperature probes.

About the Authors: Anuradha Chowdhary * E-mail: dranuradha@hotmail.com Affiliation: Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India ORCID http://orcid.org/0000-0002-2028-7462 Cheshta Sharma Affiliation: Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India Jacques F. Meis Affiliations Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands, Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, the Netherlands ORCID http://orcid.org/0000-0003-3253-6080Citation: Chowdhary A, Sharma C, Meis JF (2017) Candida auris: A rapidly emerging cause of hospital-acquired multidrug-resistant fungal infections globally. The species exhibits a close phylogenetic relationship to C. haemulonii and is differentiated based on sequence analysis of the D1/D2 domain of the large ribosomal subunit (LSU) of 26S rRNA gene and the internal transcribed spacer (ITS) regions of the nuclear rRNA gene operon [23]. [...]Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is considered a more rapid and robust diagnostic technique for C. auris identification [9, 10, 13, 16]. Worldwide reports of Candida auris along with their misidentification using commercial systems and frequency of antifungal resistance. https://doi.org/10.1371/journal.ppat.1006290.t001 Does genetic predisposition make C. auris virulent? A recently published draft genome of C. auris shows that it has a genome size of approximately 12.3 Mb [26, 27]. The emerging Candida auris: characterization of growth phenotype, virulence factors, antifungal activity, and effect of SCY-078, a novel glucan synthesis inhibitor, on growth morphology and biofilm formation. Identification and typing of the emerging pathogen Candida auris by matrix-assisted laser desorption ionisation time of flight mass spectrometry...

Transmission of multidrug-resistant Candida auris infection has been reported in the USA. To better understand its emergence and transmission dynamics and to guide clinical and public health responses, we did a molecular epidemiological investigation of C auris cases in the USA. In this molecular epidemiological survey, we used whole-genome sequencing to assess the genetic similarity between isolates collected from patients in ten US states (California, Connecticut, Florida, Illinois, Indiana, Maryland, Massachusetts, New Jersey, New York, and Oklahoma) and those identified in several other countries (Colombia, India, Japan, Pakistan, South Africa, South Korea, and Venezuela). We worked with state health departments, who provided us with isolates for sequencing. These isolates of C auris were collected during the normal course of clinical care (clinical cases) or as part of contact investigations or point prevalence surveys (screening cases). We integrated data from standardised case report forms and contact investigations, including travel history and epidemiological links (ie, patients that had shared a room or ward with a patient with C auris). Genetic diversity of C auris within a patient, a facility, and a state were evaluated by pairwise differences in single-nucleotide polymorphisms (SNPs). From May 11, 2013, to Aug 31, 2017, isolates that corresponded to 133 cases (73 clinical cases and 60 screening cases) were collected. Of 73 clinical cases, 66 (90%) cases involved isolates related to south Asian isolates, five (7%) cases were related to South American isolates, one (1%) case to African isolates, and one (1%) case to east Asian isolates. Most (60 [82%]) clinical cases were identified in New York and New Jersey; these isolates, although related to south Asian isolates, were genetically distinct. Genomic data corroborated five (7%) clinical cases in which patients probably acquired C auris through health-care exposures abroad. Among clinical and screening cases, the genetic diversity of C auris isolates within a person was similar to that within a facility during an outbreak (median SNP difference three SNPs, range 0–12). Isolates of C auris in the USA were genetically related to those from four global regions, suggesting that C auris was introduced into the USA several times. The five travel-related cases are examples of how introductions can occur. Genetic diversity among isolates from the same patients, health-care facilities, and states indicates that there is local and ongoing transmission. US Centers for Disease Control and Prevention

Candida auris is an emerging fungal pathogen that is often resistant to major classes of antifungal drugs. It is considered a serious global health threat because it can cause severe infections with frequent mortality in more than a dozen countries. It can survive on healthcare environmental surfaces for at least 7 days and can cause outbreaks in healthcare facilities. Clearly, infection prevention strategies, such as surface disinfection, will be essential to controlling Candida transmission. Unfortunately, data on the activity of antiseptics and disinfectants used in healthcare to inactivate this pathogen are limited. 1 – 5 In this study, we investigated 12 different disinfectants (ie, 8 low- and intermediate-level disinfectants in 2 dilutions of sodium hypochlorite and 5 high-level disinfectants/chemical sterilants) and 9 antiseptics commonly used in healthcare facilities for their antimicrobial activity against C. auris and C. albicans .

Candida auris transmission surged in long-term acute-care hospitals (LTACHs) in Orange County, California, USA, during the COVID-19 pandemic. This study describes the effect of COVID-19 on C. auris transmission by estimating the probability of patient colonization in LTACHs across 5 epidemiologic time periods. Patients had the highest probability of developing new skin colonization during the first COVID-19 wave, with a cumulative incidence of 22.5% (95% CI 18.5--26.6) after a 30-day stay. Once the initial COVID-19 waves abated, a reduction in cumulative incidence of C. auris colonization was observed concurrently with persistent high prevalence, indicating that within-facility transmission can be reduced with proper infection prevention and control practices. Admission screenings and point prevalence surveys provided a wealth of data that guided public health recommendations and supported the objectives of both public health professionals and LTACHs for monitoring facility transmission dynamics and guiding decision making.

Candida auris is considered a nosocomial pathogen of high concern and is currently spreading across the United States. Infection control measures for C. auris focus mainly on healthcare facilities, yet transmission levels may already be significant in the community before outbreaks are detected in healthcare settings. Wastewater-based epidemiology (culture, quantitative PCR, and whole-genome sequencing) can potentially gauge pathogen transmission in the general population and lead to early detection of C. auris before it is detected in clinical cases. To learn more about the sensitivity and limitations of wastewater-based surveillance, we used wastewater-based methods to detect C. auris in a southern Utah jurisdiction with no known clinical cases before and after the documented transfer of colonized patients from bordering Nevada. Our study illustrates the potential of wastewater-based surveillance for being sufficiently sensitive to detect C. auris transmission during the early stages of introduction into a community.

Candida auris is an emerging, often multidrug-resistant pathogen with important public health implications. Infections are associated with high mortality, and prevention of transmission requires stringent infection control measures, making C. auris a potential barrier to transplantation. We describe the first donor-derived C. auris transmission in a lung transplant recipient.

[...]C. auris cases in England predominantly appeared in specialist hospitals that clustered around the principal entry points of people traveling to and from endemic areas, which, to an extent, also reflects the geographical spread of immigrant communities. Before the end of 2017, laboratories that employed matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) for yeast identification using the Bruker platform were theoretically able to adequately identify this emerging pathogen. [...]the MRL has recently investigated the utility of a novel chromogenic agar (CHROMagar Candida Plus) developed specifically to facilitate detection and identification of C. auris. UK Public Health responses to C. auris Following the identification of 2 English hospitals with the first heathcare-associated outbreaks of C. auris in Europe [6,10], in 2016, a national incident management team (IMT) was convened by PHE in order to develop a consistent national response to this emerging nosocomial pathogen.

The initial description of C. auris arose following the isolation of a novel species from the ear canal of a patient in a Japanese hospital [2]. Since this report in 2009, cases have subsequently appeared in hospitals in South Korea, India, the Middle East, South Africa, and South America [6–10]. First hospital outbreak of the globally emerging Candida auris in a European hospital. First report of Candida auris in America: Clinical and microbiological aspects of 18 episodes of candidemia. First three reported cases of nosocomial fungemia caused by Candida auris.