Francesco Pallotta, Pierluigi Viale, Francesco Barchiesi
{"title":"耳念珠菌:新的真菌威胁。","authors":"Francesco Pallotta, Pierluigi Viale, Francesco Barchiesi","doi":"10.53854/liim-3103-6","DOIUrl":null,"url":null,"abstract":"<p><p><i>Candida auris</i> 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, <i>C. auris</i> 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 <i>C. auris</i>, 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 <i>C. auris</i>. However, commonly used biochemical tests frequently misidentify <i>C. auris</i> as other <i>Candida</i> 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 <i>C. albicans</i> 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, <i>C. auris</i> 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.</p>","PeriodicalId":52423,"journal":{"name":"Infezioni in Medicina","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495051/pdf/1124-9390_31_3_2023_323-328.pdf","citationCount":"0","resultStr":"{\"title\":\"<i>Candida auris:</i> the new fungal threat.\",\"authors\":\"Francesco Pallotta, Pierluigi Viale, Francesco Barchiesi\",\"doi\":\"10.53854/liim-3103-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><i>Candida auris</i> 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, <i>C. auris</i> 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 <i>C. auris</i>, 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 <i>C. auris</i>. However, commonly used biochemical tests frequently misidentify <i>C. auris</i> as other <i>Candida</i> 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 <i>C. albicans</i> 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, <i>C. auris</i> 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.</p>\",\"PeriodicalId\":52423,\"journal\":{\"name\":\"Infezioni in Medicina\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495051/pdf/1124-9390_31_3_2023_323-328.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Infezioni in Medicina\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.53854/liim-3103-6\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infezioni in Medicina","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.53854/liim-3103-6","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
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.
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.