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Intern Med J. 2019 Aug 19. doi: 10.1111/imj.14612. [Epub ahead of print]

Diagnosis, management and prevention of Candida auris in hospitals: Position statement of the Australasian Society for Infectious Diseases.

Author information

1
Department of Microbiology, The Canberra Hospital, Canberra; Department of Infectious Diseases, The Canberra Hospital, Canberra, ACT, Australia.
2
Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW.
3
Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Westmead, Sydney, NSW.
4
Infection Management and Prevention Services, Queensland Children's Hospital, Childrens Health Queensland; School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia.
5
National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia.
6
Department of Microbiology and Infectious Diseases, St. Vincent's Hospital, Sydney, NSW.
7
Department of Infectious Diseases, Royal Melbourne Hospital, Victorian Infectious Diseases Service at the Doherty Institute for Infection and Immunity, Melbourne, VIC.
8
Clinical Microbiology Laboratory, Auckland City Hospital, Auckland, New Zealand.
9
Department of Infectious Diseases, Alfred Health and Central Clinical School, Monash University, Melbourne, VIC.
10
Infection Control Unit, Hornsby Ku-ring-gai Health Service, Northern Sydney Local Health District, Sydney, NSW.
11
Department of Infectious Diseases, Peter MacCallum Cancer Centre; Victorian Infectious Diseases Service at the Doherty Institute for Infection and Immunity, Melbourne; NHMRC National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
12
Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne; NHMRC National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne; NHMRC National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Melbourne; Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Peter Doherty Institute, Melbourne; Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC.
13
Department of Microbiology, PathWest Laboratory Medicine FSH Network, Fiona Stanley Hospital, Murdoch; Department of Infectious Diseases, Fiona Stanley Hospital, Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia.
14
Faculty of Health & Medical Sciences, University of Western Australia, Crawley, WA, Australia.

Abstract

Candida auris is an emerging drug-resistant yeast responsible for hospital outbreaks. This statement reviews the evidence regarding diagnosis, treatment and prevention of this organism and provides consensus recommendations for clinicians and microbiologists in Australia and New Zealand. C. auris has been isolated in over 30 countries (including Australia). Bloodstream infections are the most frequently reported infections. Infections have crude mortality of 30 to 60%. Acquisition is generally healthcare-associated and risks include underlying chronic disease, immunocompromise and presence of indwelling medical devices. C. auris may be misidentified by conventional phenotypic methods. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry or sequencing of the internal transcribed spacer regions and/or the D1/D2 regions of the 28S ribosomal DNA are therefore required for definitive laboratory identification. Antifungal drug resistance, particularly to fluconazole, is common, with variable resistance to amphotericin B and echinocandins. Echinocandins are currently recommended as first-line therapy for infection in adults and children ≥2 months of age. For neonates and infants <2 months of age, amphotericin B deoxycholate is recommended. Healthcare facilities with C. auris should implement a multimodal control response. Colonised or infected patients should be isolated in single rooms with Standard and Contact Precautions. Close contacts, patients transferred from facilities with endemic C. auris or admitted following stay in overseas healthcare institutions should be pre-emptively isolated and screened for colonisation. Composite swabs of the axilla and groin should be collected. Routine screening of healthcare workers and the environment is not recommended. Detergents and sporicidal disinfectants should be used for environmental decontamination. This article is protected by copyright. All rights reserved.

KEYWORDS:

Candida auris; antifungal; infection prevention; microbiology; mycology

PMID:
31424595
DOI:
10.1111/imj.14612

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