Candida auris

Candida auris (C. auris) is a multi-drug resistant fungus (yeast) that can cause serious infections. Infections caused by C. auris are difficult to treat and are associated with increased mortality and high health care costs.

It was first recognised in 2009 in Japan where it was isolated from a sample taken from a patient with a localised ear infection. Subsequently there has been emergence of the organism in many countries including Australia.

Signs and symptoms

In many cases, a person may carry C. auris in their body or on medical devices in their body (such as feeding tubes, intravenous catheters, urinary catheters and central lines) and not have any symptoms (this is called colonisation).

People can also become very sick from C. auris infection, which can include bloodstream infections, as well as specific infections of various body parts, such as bones (osteomyelitis), ear (otitis media), brain lining (meningitis), heart lining (pericarditis), urinary tract infections or wound infections. The signs and symptoms a person who has a C. auris infection might experience depends on the site of the infection.

Transmission

C. auris can spread through person-to-person contact with a colonised or infected person by direct contact or via uncleaned surfaces and patient-shared equipment. C. auris can also persist in an uncleaned environment, allowing for transmission between patients.

Identifying C. auris is critical to knowing what steps to take to manage it in a healthcare setting, residential aged care facilities and long-term care facilities, including implementation of appropriate infection prevention and control measures.

Risk factors for acquisition

• The most significant risk factor for acquisition of C.auris is overseas hospitalisation.
• Refer to SA Health You’ve Got What Candida auris page for patient/consumer information.

Surveillance

Awareness that a person may be at risk of being colonised with C.auris on admission to a healthcare setting is important in preventing further transmission. 

At risk patients along with close contacts of newly identified cases should be screened with axilla and inguinal (groin) swabs.The laboratory should be notified that the screen is for C.auris. At risk patients being screened for C.auris should be isolated and managed as per standard and transmission-based contact precautions until the result is known. Patients with a positive culture will remain positive indefinitely.

C.auris is a notifiable disease in South Australia.

Infection prevention and control staff should work with their laboratory to ensure they are promptly alerted when C.auris is suspected. Any suspected or confirmed case should be notified to the Communicable Disease Control Branch.

Infection control management

All patients identified with C. auris should be managed in a single room with a dedicated bathroom, ensuring strict adherence with standard and contact precautions including hand hygiene.

Rooms should be cleaned daily (at a minimum) with 1000 ppm available chlorine solution (or a TGA approved surface disinfectant with activity against Clostridioides difficile) and consideration given to discarding difficult to decontaminate items at time of patient discharge.

Shared patient equipment should be cleaned and disinfected after each patient use.  Particular care needs to be taken when undertaking dressings, and managing or changing urinary catheters and other devices.

Refer to the “Further Information” section for links to infection control guidance documents.

Treatment

As C. auris is frequently resistant to multiple antifungals, individual treatment of patients should be guided by an infectious diseases physician or clinical microbiologist.

Further information

Refer to the Australasian Society for Infectious Diseases (ASID) Diagnosis, management and prevention Candida auris in hospitals: position statement.

Other useful reference guides including screening and infection control guideline documents which have been created by Health Victoria and Queensland Health. The Centers for Disase Control and Prevention (CDC) has a useful set of information sheets for patients, laboratory staff and infection prevention and control staff.

For further information on the management on C. auris, contact SA Health’s Communicable Disease Control Branch.