Prevalence of Candida auris in Canadian Acute-Care Hospitals Among At-Risk Patients

To identify the prevalence of C. auris in Canadian patients who are potentially at risk for colonization, Garcia-Jeldes, et al. (2020) screened 488 patients who were either hospitalized abroad, had a carbapenemase-producing organism (CPO), or were in units with high antifungal use. Two patients were colonized with C. auris; both had received healthcare in India and had a CPO. Among 35 patients who had recently received healthcare in the Indian subcontinent and were CPO colonized or infected, the prevalence of C. auris was 5.7%.

Candida auris is an emerging multidrug resistant pathogen associated with global hospital outbreaks. Similar to other Candida species, the crude mortality rate of candidemia due to C. auris is 30–60%.

C. auris infection was first reported from Japan in 2009. Retrospective review of a large isolate collection identified an isolate from 1996, however, it appears that C. auris has very rarely caused human infection in the past. Over the last decade, four distinct clades of C. auris have emerged and evolved independently, with frequent inter-hospital and inter-country transmission. A single isolate belonging to a potential fifth clade was recently identified in Iran. Whether the ongoing emergence of C. auris in different parts of the world will be mainly driven by the transmission of known clades, or whether new clades will continue to emerge remains uncertain.

There have been case reports of importation of C. auris by patients with recent exposure to healthcare in a country where C. auris is documented; these patients are often co-colonized with a carbapenemase producing organism (CPO). C. auris infection is often associated with underlying illnesses and outbreaks have been reported in intensive care units in multiple countries. C. auris infection is also associated with previous exposure to antibiotics or antifungals. Immunocompromised patient populations such as those in haematology/oncology wards or solid organ transplant wards often receive prophylactic antifungals; additionally, antifungal use was reported to be higher in ICUs compared to non-ICU wards [18]. Many of the risk factors for C. auris colonization are also risk factors for CPO colonization; these common risk factors include critical illness and comorbid conditions, prolonged hospitalization, and receipt of antimicrobials. This may explain why patients who are colonized with C. auris are often co-colonized with a CPO.

As the authors observe, "As of March 2020, 24 cases of C. auris colonization and infection in Canada have been voluntarily reported to the Public Health Agency of Canada. The first case of multi-drug resistant C. auris was identified in Canada in 2017 in a patient who had recently received healthcare in the Indian subcontinent and was co-colonized with a carbapenemase-producing organism (CPO). C. auris is reportable in only one of 13 Canadian provinces and territories, and there is little data or recommendations to inform screening programs. We aimed to identify the prevalence of C. auris in Canada to inform national guidelines for screening and infection prevention and control."

Source: Garcia-Jeldes HF, et al. Prevalence of Candida auris in Canadian acute care hospitals among at-risk patients, 2018. Antimicrobial Resistance & Infection Control. Vol. 9, No. 82. 2020.

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