Candida auris (C. 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 member of this group that can cause serious infections, including bloodstream, wound and ear infections.

Most people who carry the fungus on their body do not get sick from it. People who carry it without being unwell are described as “colonised”, and once colonised a person is generally considered to be colonised for life.

C. auris infections are concerning because they can be harder to treat than other candida infections, as the fungus is often resistant to antifungal medicines.

How C. auris spreads#

C. auris can cause problems in hospitals and nursing homes because it can pass from one patient to another, or spread via shared equipment and contamination of the environment. It can spread more easily from person to person than other types of Candida. It is not spread through the air by coughing or sneezing.

Risk factors#

In healthy people, C. auris colonisation does not generally cause ill health. People may carry it on their skin without any symptoms.

The risk of developing an actual infection is higher in some people, such as those whose immune system is weak or compromised, those who are already unwell with other conditions, and those who have had a hospital stay in an area with documented or suspected C. auris.

How C. auris is diagnosed#

In most cases people carry the fungus on their body without any symptoms. Because colonised people may not know they have it, testing allows healthcare providers to identify who is carrying the fungus and take steps to prevent it from spreading.

For a colonisation (or screening) test, a nurse or doctor wipes a cotton swab on the skin near the armpits and the groin (where the leg joins the body). The test is not painful. The swab is sent to a laboratory with the specific technology needed to identify C. auris, which can be difficult to detect without it.

If you are found to be carrying the fungus, your nurse or doctor will talk to you about the results and the next steps.

Active infections – such as bloodstream, wound or ear infections – are diagnosed in the same way as other infections. Depending on the site of the infection, a blood sample, a wound or ear swab, or another specimen is sent to the lab to be cultured. The lab identifies that C. auris is causing the infection and reports this back to your treating doctor.

Treatment#

Most C. auris infections are treatable with antifungal drugs called echinocandins. However, some C. auris infections are resistant to the main types of antifungal medication, which makes them harder to treat. In that situation, multiple antifungals at high doses may be required. Your doctor will provide more specific information about any treatment you may need.

There is currently no evidence that colonisation can be cured with antifungal medications, so treatment is not required or recommended for people who carry C. auris without any symptoms or signs of infection. Giving antifungal medications to people who are colonised but not infected may be harmful and can increase the chance of an infection developing.

What happens in hospital#

While you wait for test results, if you are in hospital you may be placed in a single room. A sign will be placed on the door to remind health care workers to take special precautions, such as wearing a gown and gloves, before entering. An alert may also be added to your hospital record so that staff know extra precautions are needed if you are admitted again.

Everyone – including you and your visitors – should wash their hands or use an alcohol-based hand rub before entering and leaving the room. Visitors should keep practising good hand hygiene, washing their hands or using an alcohol-based hand rub before and after touching patients or items around the bedside.

Your family and friends can still visit you.

After you leave hospital#

Although you may be well enough to be discharged, you are still considered to be carrying C. auris and will need to take extra precautions any time you are admitted to a healthcare facility in future.

If you attend another healthcare facility, see a healthcare provider (such as a doctor or physiotherapist), or receive home care services, tell them that you carry C. auris. Where possible, take your hospital discharge summary with you.

There is no need to inform community facilities or businesses that are not healthcare-related, such as a public swimming pool. Importantly, having C. auris does not affect your access to treatment and care in any way.

Caring for yourself at home#

No special precautions are needed at home once you have been discharged, but you and your family should follow good general hygiene. Always wash your hands with soap and water:

• before and after touching any wounds or medical devices you may have
• after going to the toilet
• before preparing and eating food

Other simple steps:

• Use your own towels and face cloths, and do not share them with other people.
• Cover any wounds with a bandage whenever possible.

No special cleaning is required in your home. Clothing can be laundered as usual, along with the rest of the household laundry, and all eating utensils and dishes can be washed the way you normally do. Remember to tell any healthcare facilities or providers that you have been found to carry C. auris.

Key points#

• C. auris is an uncommon fungus that can cause serious bloodstream, wound and ear infections.
• It can cause problems in hospitals and nursing homes because it spreads between patients and via shared objects.
• In most cases people carry the fungus on their body without any symptoms or infection.
• It is often resistant to antifungal medicines, so infections can be harder to treat and may need multiple antifungals at high doses.
• Good hand hygiene and standard precautions are the main ways to prevent its spread.

Where to get help#