Candida auris (Candidozyma auris): what patients and visitors should know

Candida auris, now called Candidozyma auris and often shortened to C. auris, is a yeast, a type of fungus. A Worcestershire Acute Hospitals NHS Trust leaflet describes it as a fungus that lives on the skin and inside the human body and says it is much less common than other Candida fungi, such as Candida albicans, which causes thrush.

Some people carry C. auris without realising it. The leaflet explains that carriers have no symptoms and do not become unwell. The concern in hospitals is that it can occasionally get into surgical wounds or the bloodstream during medical treatment, including operations, or when a urinary catheter or drip is inserted. Infections are usually minor but can become more serious, although serious infections are rare.

UKHSA guidance distinguishes patients who are colonised (carry the yeast on or in the body) from those who are infected. It says patients who are only colonised should not be offered treatment unless there are clear signs or symptoms of clinical infection.

The leaflet says potential symptoms of infection include pus at a wound, and a rise in temperature with feeling generally unwell if a drip line or urinary catheter is infected. It also describes C. auris as able to cause bloodstream, wound and ear infections. If you are in hospital and feel worse, tell staff; at home the leaflet advises calling your GP, NHS 111 or 999 if symptoms or condition worsen.

Exactly how C. auris spreads is still being investigated, but the leaflet says it appears to be transmitted from person to person in hospitals. It is difficult to clear completely from the environment and is easy to pick up on clothes, equipment and hands. UKHSA guidance lists prolonged exposure to broad-spectrum antibiotics and antifungals among the identified risk factors for colonisation and infection.

The guidance recommends screening patients who have had an overnight stay in a healthcare facility outside the UK in the previous year, and those coming from affected units in the UK. It also advises screening contacts of patients with C. auris, and says healthcare workers and the environment should not be routinely screened.

The NHS leaflet says a healthcare professional takes swabs from the nose, armpit (axilla), groin, urine and wounds. This may happen on admission if the patient is coming from abroad, or during a stay if the patient has been identified as a contact of a known positive case. UKHSA guidance says screening swabs should cover the axilla, groin and nose, with further sites added depending on the clinical picture.

In the laboratory, UKHSA recommends full identification of suspected isolates using MALDI-TOF mass spectrometry or a robust molecular method, rather than biochemical methods, and antifungal susceptibility testing on invasive isolates and those from patients who need treatment.

UKHSA recommends that patients colonised or infected with C. auris are isolated or cohorted, ideally in a single room with en-suite facilities, with contact precautions. Staff and visitors may wear gowns, aprons and gloves, and hospitals use enhanced hand hygiene and enhanced cleaning of affected areas.

The guidance says there is currently no evidence to support ending isolation during the hospital stay, because carriage appears to be prolonged. Continuous carriage for more than a year has been documented, so a precautionary approach is advised on readmission. UKHSA advises against routine decolonisation therapy, as colonisation may persist despite various approaches.

The leaflet says patients with a C. auris infection will usually be treated with antifungal medicines and treated before discharge. UKHSA guidance recommends an echinocandin as first-line empirical treatment for infection in adults, children and neonates, and says most isolates are resistant to fluconazole so it should not be used. Liposomal amphotericin is recommended where the yeast is echinocandin-resistant, treatment is failing, or the infection is at sites such as the brain or eye that echinocandins reach poorly.

Because resistance can develop during treatment, the guidance says patients should be monitored with follow-up cultures and repeat susceptibility testing. Complicated cases should involve clinicians with a specialist interest in mycology.

The leaflet advises patients to avoid touching broken skin or wound dressings and to wash their hands regularly, especially after using the toilet and before eating. Visitors should wash their hands and use alcohol gel before and after touching patients or items around the bed.

After going home, no special treatment is needed for people found to be carrying C. auris, but the leaflet says anyone who knows they are, or have been, a carrier should tell hospital staff on readmission. This helps the hospital make the right infection control arrangements.