Emergent Care / Stabilization:
Given that many Candida auris strains are resistant to a variety of antifungal medications, management should be guided by antifungal susceptibility testing and in consultation with an infectious diseases specialist. Empiric management with echinocandins should be considered in those with fungemia pending susceptibility testing.

Diagnosis Overview:
First isolated from the ear canal of a Japanese patient in 2009, Candida auris has since become a pathogen of significant concern and is currently labeled as an urgent threat by the US Centers for Disease Control and Prevention (CDC) as well as a critical priority for public health action and ongoing research by the World Health Organization (WHO).

A species of yeast that can cause severe disease in humans, C auris has been primarily identified in patients in health care facilities and long-term care facilities. Just like other members of the Candida species, C auris runs the gambit from colonization to infection, causing a range of conditions from superficial cutaneous infection to life-threatening deep tissue infections and fungemia.

Complicating the clinical care of patients with identified C auris infection, the fungus is resistant to a variety of first-line antifungal medications.

Candida auris has also been demonstrated to spread rapidly in health care settings, both from patients who are colonized and those with active infection. The yeast can survive on surfaces for prolonged periods of time and can be transmitted from patient to patient by health care providers, medical equipment, and via contaminated environmental surfaces. The majority of outbreaks of C auris have been in high acuity post-acute care facilities as opposed to acute care facilities.

Risk factors for both colonization and ultimately infection with C auris are similar to those with other Candida species, such as advanced age, indwelling medical devices, hemodialysis, immunocompromise, diabetes, and recent surgery.

The infection, like most candidal infections, primarily affects patients with underlying medical conditions requiring invasive monitoring or device management (ie, vascular catheters, urinary catheters, breathing tubes, feeding tubes). Healthy individuals have minimal risk of infection from C auris.

For details on infectious presentations, see disseminated candidiasis and neonatal candidiasis.