Candida auris Infection | Fungal Infections | JAMA | JAMA Network
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JAMA Patient Page
October 15, 2019

Candida auris Infection

Author Affiliations
  • 1University of Michigan Medical School, Ann Arbor
  • 2Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
JAMA. 2019;322(15):1526. doi:10.1001/jama.2019.13857

Candida auris is a new form of yeast that is easily spread between patients and can be very difficult to treat.

What Is Candida auris?

Yeasts can infect people, and one of the common types of yeast is called Candida. The Candida auris species was unrecognized before 2009. Many genetically unrelated forms of C auris have emerged in different parts of the world for unknown reasons. Use of antifungal drugs in people or animals or fungicides in agriculture may play a role. This yeast has caused outbreaks of infection in hospitals and nursing homes. Unlike other yeasts that originate in human bodies, C auris can be acquired from the health care environment and spread from patient to patient. Candida auris can cause serious infections of the bloodstream, gut, wounds, and other sites. Some infections are resistant to all antifungal drugs and do not respond to treatment; death rates from this infection can reach 60%. Some patients may have C auris on their skin or in their rectum, wounds, or mouth, but they feel well and have no symptoms of infection. This condition is called asymptomatic colonization, and treatment with antifungal drugs does not eliminate C auris colonization.

Acquisition of C auris

People who get C auris infection are frequently very sick, have many illnesses, and tend to remain in health care facilities for a long time. Patients with impaired immunity or who require feeding tubes and intravenous or urinary catheters have a high risk of acquiring C auris infection. Healthy people, including health care workers, with very rare exception do not become colonized or infected with C auris. As a result, routine screening of contacts of patients with C auris is not recommended unless they also are admitted to a health care facility.

Controlling and Preventing Spread of C auris

Detection of C auris is difficult in most hospitals. Most clinical laboratories do not have the ability to differentiate C auris from other yeasts. Physicians must suspect C auris infection specifically and send cultures of yeast to special laboratories for confirmation. When being admitted to the hospital, patients (or their families) should alert physicians if they have had a diagnosis of C auris or stayed in a health care facility where C auris was present. If there is concern that a patient has been exposed to C auris, they must be placed in isolation as a precaution until the diagnosis is confirmed.

Isolation for C auris requires placing patients in private rooms or placing patients with diagnosis of C auris together. All health care personnel and visitors must wear gowns and gloves when entering the room and wash their hands frequently. The room environment is cleaned frequently with special disinfectants. Cultures of specimens obtained from patients may grow C auris for up to 3 months after it is first detected. Repeat cultures may be done to see if isolation can be discontinued.

In nursing facilities, patients infected with C auris may attend group activities if they can wash their hands, wear clean clothing, and have wounds that can be contained by clean bandages, and if common areas are frequently disinfected.

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Conflict of Interest Disclosures: None reported.

Source: Bradley SF. What is known about Candida auris [published online September 6, 2019]. JAMA. doi:10.1001/jama.2019.13843

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