Multidrug-Resistant Candida auris

Candida auris is a recently described emerging fungus that simultaneously appeared in several locations worldwide. Some isolates of C. auris have shown resistance to one or more antifungal agents. Since 2016, 47% of confirmed clinical C. auris cases within the U.S. have been in New York. Now, investigators in New York have found three patients with isolates that are resistant to three different classes of antifungals (azoles, polyenes, and echinocandins).

All three patients resided in long-term care facilities, had multiple comorbidities, and had no history of recent foreign or domestic travel. The organisms were identified by culture, polymerase chain reaction testing, or both and were confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. From the first two patients identified as pan-resistant, all isolates were initially resistant to fluconazole and about half were resistant to amphotericin B. No isolate was resistant to echinocandins initially, but resistant isolates were found after treatment with this drug. The third patient, identified retrospectively after the first two cases were reported, was cared for at different facilities from the other two patients. Serial isolates were initially resistant to fluconazole, had variable amphotericin B resistance, and developed echinocandin resistance after 2 weeks of treatment with this drug class. There was no evidence of transmission among these patients or from these patients to other inhabitants of the care facilities.