Candida auris Isolates Resistant to Three Classes of Antifungal Medications — New York, 2019

Belinda Ostrowsky, MD; Jane Greenko, MS; Eleanor Adams, MD; Monica Quinn, MS; Brittany O'Brien, MS; Vishnu Chaturvedi, PhD; Elizabeth Berkow, PhD; Snigdha Vallabhaneni, MD; Kaitlin Forsberg, MPH; Sudha Chaturvedi, PhD; Emily Lutterloh, MD; Debra Blog, MD

Disclosures

Morbidity and Mortality Weekly Report. 2020;69(1):6-9. 

In This Article

Discussion

The precise mechanism of resistance in these isolates is unknown, although echinocandin resistance in other species of Candida is linked to mutations in the drug target protein Fks1.[7] Approximately 3 years into the New York outbreak, these pan-resistant isolates still appear to be rare, but their emergence is concerning. In other countries with earlier emergence of C. auris, higher levels of echinocandin resistance and pan-resistance have been reported.[8] An isolate from Illinois with development of echinocandin resistance after echinocandin treatment was recently described, although that isolate was susceptible to azoles.[9] The pan-resistant cases reported here were all from New York, where the South Asia clade (clade 1) predominates.[5] This clade is known to exhibit increased antifungal resistance compared to other clades of C. auris.[8] Surveillance for additional pan-resistant isolates in New York is ongoing.

Echinocandins are the treatment of choice for C. auris infections.[1] Most New York C. auris strains are fluconazole-resistant, and most strains of C. auris have been susceptible to echinocandins.[1] However, because of the potential for development of resistance, patients on antifungal treatment for C. auris should be monitored closely for clinical improvement, and follow-up cultures should be obtained. Repeat susceptibility testing should also be conducted, especially in patients previously treated with echinocandins. Consultation with an infectious disease specialist is recommended, especially given the possibility of emergence of pan-resistance.

These findings illustrate the need to continue surveillance for C. auris, encourage prudence in the use of antifungal medications, and conduct susceptibility testing on all clinical isolates, including serial isolates from a single patient, especially those treated with echinocandins.

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