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Candida auris

C. auris

Morphology: Yeast, often misidentified by older biochemical methods; MALDI-TOF or molecular ID required.

Yeast

Typical drugs

  1. #1Micafungin— First-line — most isolates susceptible (initial therapy).
  2. #2Caspofungin
  3. #3Amphotericin B (liposomal)— If echinocandin resistance — ~30% of US isolates.

Empiric therapy when resistant

Start empiric echinocandin. If pan-resistant: liposomal amphotericin B + flucytosine combo, ID consult mandatory. CDC tracking — report cases to public health.

Resistance mechanisms

  • Target alteration

    Erg11 mutations (azole resistance) and FKS1 mutations (echinocandin resistance)

    Example: Pan-resistant strains reported (resistant to all 3 antifungal classes).

  • Efflux pump

    Upregulated efflux pumps

    Example: Multi-azole resistance.

Resistance notes

WHO critical priority pathogen. ~90% fluconazole-resistant, ~30% amphotericin-resistant, ~5% echinocandin-resistant in US. Pan-resistant outbreaks reported.

Pearls

Highly transmissible in healthcare settings — contact isolation, daily chlorhexidine bathing, environmental decontamination with sporicidal agents (UV / H2O2). Persists on surfaces for weeks. Notify infection control AND public health on detection.

References