Candida auris (C. auris)

About Candida auris

Candida is a genus of fungi (yeasts) that live on the skin and inside the human body. Candida auris (also called C. auris) is an uncommon fungus that can cause serious infections.

Most people who carry the fungus on their body do not get sick from it, but sometimes it can lead to serious bloodstream, wound and ear infections. People who carry the fungus (known as colonisation) are considered to be colonised for life.

Infections caused by C. auris are concerning because they can be more difficult to treat than other candida infections, as they are often resistant to medicines.

Candida auris can also spread more easily from person to person than other types of Candida. For this reason, C. auris can cause problems in hospitals and nursing homes as it can spread from one patient to another or via shared objects.

Transmission of Candida auris

Australia has had very few identified cases of C. auris to date. All of the cases found in Australia so far have been in people who were in hospital overseas where C. auris is more common.

In most cases, people carry the fungus somewhere on their body without it causing any symptoms or an infection. This is called colonisation. People who are colonised with C. auris do not have any symptoms and may not know they have it and can pass the fungus to another person.

Candida auris can also be spread via equipment that has been shared between patients or through contamination of the environment. It is not spread through the air by coughing or sneezing.

Risk factors for Candida auris

In healthy people, C. auris colonisation does not generally cause ill health. People may carry C. auris on their skin without any symptoms. However, these individuals are at risk of getting C. auris infection if they are hospitalised for another reason, or put on antibiotics.

In some people, such as those whose immune system is weak or compromised or who are already unwell with other conditions, C. auris can become a serious problem as it can cause serious bloodstream, wound or ear infections.

C. auris is more likely to affect patients who have:

• a hospital stay in an area with documented or suspected C. auris transmission
• a prolonged hospital stay
• an indwelling medical device, such as a central venous catheter, urinary catheter, biliary catheter or wound drain
• an impaired immune system
• multiple or recent exposures to broad spectrum antibiotics
• diabetes mellitus
• had recent surgery.

Diagnosis of Candida auris

People who have not been in contact with a known case of C. auris during an admission to a healthcare facility do not need to be tested.

If you have come in contact with C. auris while you were in a healthcare facility, you may be tested by the healthcare facility to see if you are now carrying the fungus. This allows healthcare providers to know who is carrying the fungus and take steps to prevent it from spreading to other people. A nurse or doctor will wipe or rub a cotton swab on the skin near your armpits and the area where your leg joins your body (your groin). The test is not painful.

The swab will be sent to a lab with specific technology capable of identifying C. auris (one complication of C. auris is that it can be difficult to identify without the right technology). Your doctor will receive the results. If the test shows you are carrying the fungus, your nurse or doctor will talk to you about the results and next steps.

Infections with C. auris, such as bloodstream, wound or ear infections, are diagnosed in the same way that other infections are found. Depending on the location of the infection, a blood sample, wound or ear swab or other specimen will be sent to the lab to be cultured. The lab will then identify that it is C. auris causing the infection and report this back to your treating doctor.

Treatment of Candida auris

Most C. auris infections are treatable with antifungal drugs called echinocandins. However, some C. auris infections are resistant to the main types of antifungal medications, making them more difficult to treat. In this situation, multiple antifungals at high doses may be required to treat the infection. Your doctor will provide more specific information regarding any treatment you may require.

As there is currently no evidence that colonisation can be cured using antifungal medications, treatment is not required or recommended for people found to be carrying C. auris without any symptoms or signs of infection.

Giving antifungal medications to people who are colonised but do not have an infection may be dangerous and increase the chances of infection developing.

Screening for Candida auris

Screening for C. auris will only occur if you’ve been in contact with a known case of C. auris and have been identified by the healthcare facility. You will have a swab test as described above in ‘Diagnosis of C. auris’ – except in this instance it is referred to as a ‘screening test’.

If you are found to be carrying the fungus, your nurse or doctor will talk to you about the test results and what you can do to prevent the spread of the fungus to other people.

While waiting for your test results, if you are in hospital, you may be placed in a single room. Staff entering the room will wear gowns and gloves in order to prevent passing the infection on to other patients.

What happens when you have Candida auris

If you are in hospital and you have C. auris, your healthcare team will take the following extra precautions to prevent the spread of C. auris to other patients.

• You will be moved to a single room and a sign will be placed on your door to remind health care workers who enter your room about the special precautions they need to take, such as wearing a gown and gloves.
• Everyone, including your visitors and you, will need to wash their hands or use an alcohol-based hand rub before entering or leaving your room.
• An alert will be placed in your hospital record to alert staff, if you are admitted another time, that extra precautions are required.

Your family and friends can visit you. However, to prevent the spread of C. auris to other patients or the environment, it is important that all your visitors:

• wash their hands or use an alcohol-based hand rub before entering and leaving your room
• do not eat or drink in your room
• do not use your hospital bathroom
• do not visit any other patients in the hospital immediately after visiting you.

Once you have been diagnosed with C. auris you are considered to be colonised indefinitely. So, although you may be well enough to be discharged from hospital, you are still considered to have C. auris, and will need to take extra precautions any time you are admitted to a healthcare facility in the future.

Therefore, if you go to another healthcare facility, healthcare provider (such as a doctor or physiotherapist) or have home care services in the future, you will need to tell them that you have C. auris. Take your hospital discharge summary with you.

Prevent the spread of Candida auris

If you have been diagnosed with C. auris, where possible:

• avoid touching any areas of broken skin or wound dressings
• ensure you wash your hands or use an alcohol-based hand rub, particularly:
  • after using the toilet
  • before eating food
  • whenever you leave your hospital room.

Visitors should also continue to practice good hand hygiene and ensure they wash their hands or use alcohol-based hand rub before and after touching patients or any items around the bedside.

Candida auris at home

There is no need to take special precautions at home once you have been discharged from hospital, but it is important that you and your family remember to follow these good general hygiene practices:

• Always wash your hands with soap and water:
  • after going to the toilet
  • before preparing and eating food
  • before and after touching any wounds or medical devices that you may have.
• Use your own towels and face cloths. Do not share these items with other people.
• Cover any wounds with a bandage whenever possible.

No special cleaning is required in your home and your clothing may be laundered in the usual manner, along with the rest of the household laundry. All eating utensils and dishes can be washed the way you normally do.

Remember to inform any health care facilities or other health care providers that you have been found to have C. auris. There is no need to inform other community-based facilities or businesses that are not healthcare-related (for example, the public swimming pool). Importantly, your access to treatment and care is not in any way affected by having C. auris.

Where to get help

• Your GP (doctor)
• The infection prevention and control team at your treating healthcare facility if you have been in hospital and are concerned