Review Article Candida auris: An emerging multidrug-resistant pathogen of global significance Ziauddin Khan, Suhail Ahmad* Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait A R T I C L E I N F O Article history: Received 26 September 2017 Accepted 15 November 2017 Available online 20 November 2017 Keywords: Nosocomial pathogen Emergence Multidrug resistance Molecular identification A B S T R A C T Candida auris has recently emerged as a serious nosocomial pathogen of global significance. Although initially isolated as an agent of otitis externa from Japanese and South Korean patients, it soon became apparent that C. auris is also a potent bloodstream pathogen. With the introduction of molecular identification methods based on sequencing of rDNA and/or protein profiling, C. auris is now increasingly being isolated from clinical specimens throughout the globe. Infections due to C. auris are hospital- acquired, the organism is intrinsically resistant to multiple antifungal agents and is frequently misidentified by phenotypic methods Early diagnosis of C. auris infections is essential for better clinical outcome and the implementation of infection control measures to prevent nosocomial horizontal transmission. Outbreaks of C. auris infections in hospitalized patients have been reported from U. K., Spain and Venezuela. Since C. auris is associated with high mortality in critically ill patients, a greater awareness of its epidemiology, prevention of intra- and inter-hospital transmission, risk factors, identification methods and optimal treatment options will enable healthcare professionals to effectively manage C. auris infections. This review provides an insight into the current status of this emerging multidrug-resistant pathogen and highlights the need to develop effective management and preventive strategies. © 2017 Sir Ganga Ram Hospital. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved. Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 1.1. Global epidemiology of C. auris infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 1.2. C. auris infections in south-east Asia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 1.3. C. auris infections in the Indian subcontinent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 1.4. C. auris infections in the middle east . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 1.5. C. auris infections in Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 1.6. C. auris infections in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 1.7. C. auris infections in the United States of America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 1.8. C. auris infections in South America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 1.9. Identification of C. auris and C. haemulonii complex isolates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 1.9.1. Phenotypic identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 1.9.2. Molecular identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 1.10. Molecular epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 1.11. Pathogenicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 1.12. Antifungal resistance in C. auris strains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245 1.13. Antifungal therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246 1.14. Prevention of C. auris infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246 1.15. Future studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246 * Corresponding author at: Department of Microbiology, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait. E-mail address: suhail_ah@hsc.edu.kw (S. Ahmad). https://doi.org/10.1016/j.cmrp.2017.11.004 2352-0817/© 2017 Sir Ganga Ram Hospital. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved. Current Medicine Research and Practice 7 (2017) 240–248 Contents lists available at ScienceDirect Current Medicine Research and Practice journa l homepage: www.e lsevier.com/locate/cmrp