Candida auris in intensive care unit: A growing clinical concern

Candida auris has emerged as a significant multidrug-resistant pathogen in healthcare settings, particularly affecting critically ill patients. This pathogen has been associated with numerous global clinical outbreaks, especially in intensive care units (ICUs), which increased during the coronavirus disease 2019 (COVID-19) pandemic. The primary concern regarding C. auris in ICUs is its high transmission potential due to its ability to both colonize patients for prolonged periods and persist on surfaces. Moreover, invasive infections caused by C. auris , particularly candidemia, are linked to high morbidity and mortality rates, especially in cases of infections sustained by strains resistant to antifungals. Compounding these challenges is the pathogen’s resistance profile, characterized by substantial resistance to azoles and moderate cross-class antifungal resistance, complicating the treatment of these infections. The management of C. auris infections in ICUs is complex, driven by several critical factors. First, stringent infection control measures required, including contact isolation precautions and colonization screening protocols; the latter are not universally defined and represent a significant area of ongoing research. Second, the vulnerability of critically ill patients—due to factors such as comorbidities, immunosuppression, and extensive use of invasive devices—combined with environmental factors, underscores the need to identify specific risk factors that predispose colonized patients to develop invasive C. auris infections. Although scientific evidence is growing, a lack of comprehensive understanding in this area remains. Third, traditional culture-based diagnostic methods for candidemia have shown low sensitivity and long turnaround times, leading to increased interest in nonculture-based diagnostic tools, such as the 1,3-β-D-glucan assay, which are particularly valuable for the early detection of invasive C. auris infections in critically ill patients. Lastly, the pathogen’s challenging susceptibility profile and the absence of established clinical breakpoints for antifungals by major international reference societies further complicate the management of C. auris infections. In addition, the selection of optimal antifungal treatment must consider factors related to the pharmacokinetics and pharmacodynamics of drugs in critically ill patients, along with the exploration of new therapeutic options. This narrative literature review aims to provide an overview of current knowledge of C. auris , with a specific focus on its epidemiology, diagnosis, and management in ICUs. By analyzing recent studies, this review seeks to inform clinicians and guide strategies for managing C. auris colonization and infections and to propose future perspectives for tackling this critical pathogen.