Candida auris: the new fungal threat.

Q2 Medicine Infezioni in Medicina Pub Date : 2023-01-01 DOI:10.53854/liim-3103-6
Francesco Pallotta, Pierluigi Viale, Francesco Barchiesi
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Abstract

Candida auris is an emergent fungal pathogen of particular concern. Since its first identification in Japan in 2009, it rapidly spread all over the world, including Italy. The main concern related to the diffusion of this fungus is its antifungal resistance. It is speculated that about 90% of isolates are resistant to fluconazole, 30% to amphotericin B and 5% to echinocandins; furthermore, some cases of pan-antifungal resistance have been described. Critically ill patients are particularly at risk of being colonized by this yeast and person-to-person transmission may generate hospital outbreaks. In fact, C. auris can survive on inanimate surfaces for a long time and commonly used disinfectants are not effective. Additionally, devices such as central venous catheters (CVCs) or urinary catheters are particularly at risk of being colonized, representing a possible source for the development of bloodstream infections caused by C. auris, which carries a high mortality rate. Given its capability to spread in the hospital setting and the limited therapeutic options it is of outmost importance to promptly identify C. auris. However, commonly used biochemical tests frequently misidentify C. auris as other Candida species; currently the best identification techniques are MALDI-TOF and molecular methods, such as PCR of the ITS and D1/D2 regions of the 28s ribosomal DNA. Whole genome sequencing remains the gold standard for the phylogenetic investigation of outbreaks. The majority of cases of colonization by C. albicans will not cause bloodstream infections and contact precautions and surveillance of contacts will be sufficient. When invasive fungal infections occur, echinocandins still represent the first therapeutic choice. A combination therapy or the use of novel antifungals (such as ibrexafungerp or fosmanogepix) would be required for echinocandin resistant strains. In conclusion, C. auris represents a growing threat because of its antifungal resistance characteristics, its difficult identification and its easy spread from person to person. The aim of this mini-review is to summarize the main aspects concerning this pathogen.

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耳念珠菌:新的真菌威胁。
耳念珠菌是一种特别值得关注的新兴真菌病原体。自2009年在日本首次发现以来,它迅速蔓延到包括意大利在内的世界各地。与这种真菌扩散有关的主要问题是它的抗真菌耐药性。据推测,约90%的分离株对氟康唑耐药,30%对两性霉素B耐药,5%对棘白菌素耐药;此外,还报道了一些泛抗真菌耐药性病例。危重病人特别容易被这种酵母菌定植,人与人之间的传播可能导致医院暴发。事实上,金黄色葡萄球菌可以在无生命的表面存活很长时间,而常用的消毒剂是无效的。此外,中心静脉导管(CVCs)或导尿管等设备特别容易被定植,这可能是由C. auris引起的血流感染的一个来源,这种感染具有很高的死亡率。鉴于其在医院环境中传播的能力和有限的治疗选择,及时识别金黄色葡萄球菌至关重要。然而,常用的生化测试经常将金黄色念珠菌误认为其他念珠菌;目前最好的鉴定技术是MALDI-TOF和分子方法,如28s核糖体DNA ITS区和D1/D2区PCR。全基因组测序仍然是疫情系统发育调查的金标准。大多数白色念珠菌定植病例不会引起血液感染,接触预防和接触监测将是足够的。当侵袭性真菌感染发生时,棘白菌素仍然是首选的治疗选择。对于棘白菌素耐药菌株,需要联合治疗或使用新型抗真菌药物(如ibrexafungerp或fosmangepix)。综上所述,金黄色葡萄球菌具有抗真菌性、鉴定难度大、易人际传播等特点,威胁日益严重。这篇综述的目的是总结有关这种病原体的主要方面。
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来源期刊
Infezioni in Medicina
Infezioni in Medicina Medicine-Infectious Diseases
CiteScore
8.40
自引率
0.00%
发文量
62
期刊介绍: The Journal publishes original papers, in Italian or in English, on topics concerning aetiopathogenesis, prevention, epidemiology, diagnosis, clinical features and therapy of infections, whose acceptance is subject to the referee’s assessment. The Journal is of interest not only to infectious disease specialists, microbiologists and pharmacologists, but also to internal medicine specialists, paediatricians, pneumologists, and to surgeons as well. The Editorial Board includes experts in each of the above mentioned fields.
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