Vol. 24 No. 1 (2025): Mapana Journal of Sciences
Review Articles

The Rise of Candida auris: A Review of a Globally Emerging Multidrug-Resistant Pathogen

  • Vishal Bhoir,
  • Bela Nabar
Vishal Bhoir
Smt. CHM College, Ulhasnagar, Maharashtra, India
DOI: https://doi.org/10.12723/mjs.72.8

Published 2025-04-05

Keywords

  • Candida auris,
  • Multidrug resistance,
  • Nosocomial outbreaks,
  • Antifungal resistance,
  • Fungal pathogenesis,
  • Global epidemiology
    • ...More
    Less

Copyright (c) 2025

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Abstract

The emerging multidrug-resistant fungal pathogen Candida auris poses a serious global public health threat. Since its identification in 2009, C. auris has rapidly spread worldwide and can cause difficult-to-treat nosocomial outbreaks and invasive infections with high mortality. C. auris exhibits frequent resistance to azoles, echinocandins, and polyenes, creating challenges for its clinical management. Its ability to persistently colonise patients and contaminate hospital environments also facilitates easy transmission. This review summarises current knowledge on C. Auris global epidemiology, mechanisms of antifungal resistance, limitations of current treatments, and emerging novel therapies under investigation. Ongoing research priorities include improving diagnostics, elucidating pathogenesis, developing new therapies, and optimising infection control. Mitigating the public health risks of this formidable fungal pathogen remains an urgent goal requiring focused efforts across multiple domains.

References

  1. Abdolrasouli, A., & Fraser, M. A. (2022). Candida auris Identification and Profiling by MALDI-ToF Mass Spectrometry. Methods in Molecular Biology (Clifton, N.J.), 2517, 21–32. https://doi.org/10.1007/978-1-0716-2417-3_2
  2. Alam, H., Srivastava, V., Sekgele, W., Wani, M. Y., Al-Bogami, A. S., Molepo, J., & Ahmad, A. (2023). Cellular apoptosis and cell cycle arrest as potential therapeutic targets for eugenol derivatives in Candida auris. PLOS ONE, 18(6), e0285473. https://doi.org/10.1371/journal.pone.0285473
  3. Al-Obaid, I., Asadzadeh, M., Ahmad, S., Alobaid, K., Alfouzan, W., Bafna, R., Emara, M., & Joseph, L. (2022). Fatal Breakthrough Candidemia in an Immunocompromised Patient in Kuwait Due to Candida auris Exhibiting Reduced Susceptibility to Echinocandins and Carrying a Novel Mutation in Hotspot-1 of FKS1. Journal of Fungi, 8(3), 267. https://doi.org/10.3390/jof8030267
  4. Bandara, N., & Samaranayake, L. (2022). Emerging and future strategies in the management of recalcitrant Candida auris. Medical Mycology, 60(4). https://doi.org/10.1093/mmy/myac008
  5. Banerjee, A., Vishwakarma, P., Meena, N. K., Lynn, A. M., & Prasad, R. (2022). Bioinformatic Identification of ABC Transporters in Candida auris. Methods in Molecular Biology (Clifton, N.J.), 2517, 229–240. https://doi.org/10.1007/978-1-0716-2417-3_18
  6. Bapat, P. S., & Nobile, C. J. (2021). Photodynamic Therapy Is Effective Against Candida auris Biofilms. Frontiers in Cellular and Infection Microbiology, 11, 713092. https://doi.org/10.3389/fcimb.2021.713092
  7. Borman, A. M., & Johnson, E. M. (2020). Candida auris in the UK: Introduction, dissemination, and control. PLOS Pathogens, 16(7), e1008563. https://doi.org/10.1371/journal.ppat.1008563
  8. Burrack, L. S., Todd, R. T., Soisangwan, N., Wiederhold, N. P., & Selmecki, A. (2022). Genomic Diversity across Candida auris Clinical Isolates Shapes Rapid Development of Antifungal Resistance In Vitro and In Vivo. mBio, 13(4), e00842-22. https://doi.org/10.1128/mbio.00842-22
  9. Caballero, U., Eraso, E., Quindós, G., Vozmediano, V., Schmidt, S., & Jauregizar, N. (2023). PK/PD modeling and simulation of the in vitro activity of the combinations of isavuconazole with echinocandins against Candida auris. CPT: Pharmacometrics & Systems Pharmacology, 12(6), 770–782. https://doi.org/10.1002/psp4.12949
  10. Caballero, U., Kim, S., Eraso, E., Quindós, G., Vozmediano, V., Schmidt, S., & Jauregizar, N. (2021). In Vitro Synergistic Interactions of Isavuconazole and Echinocandins against Candida auris. Antibiotics, 10(4), 355. https://doi.org/10.3390/antibiotics10040355
  11. Černáková, L., Roudbary, M., Brás, S., Tafaj, S., & Rodrigues, C. F. (2021). Candida auris: A Quick Review on Identification, Current Treatments, and Challenges. International Journal of Molecular Sciences, 22(9). https://doi.org/10.3390/ijms22094470
  12. Chaabane, F., Graf, A., Jequier, L., & Coste, A. T. (2019). Review on Antifungal Resistance Mechanisms in the Emerging Pathogen Candida auris. Frontiers in Microbiology, 10. https://doi.org/10.3389/fmicb.2019.02788
  13. Chakrabarti, A., & Sood, P. (2021). On the emergence, spread and resistance of Candida auris: Host, pathogen and environmental tipping points. Journal of Medical Microbiology, 70(3), 001318. https://doi.org/10.1099/jmm.0.001318
  14. Chowdhary, A., Prakash, A., Sharma, C., Kordalewska, M., Kumar, A., Sarma, S., Tarai, B., Singh, A., Upadhyaya, G., Upadhyay, S., Yadav, P., Singh, P. K., Khillan, V., Sachdeva, N., Perlin, D. S., & Meis, J. F. (2018). A multicentre study of antifungal susceptibility patterns among 350 Candida auris isolates (2009–17) in India: Role of the ERG11 and FKS1 genes in azole and echinocandin resistance. Journal of Antimicrobial Chemotherapy, 73(4), 891–899. https://doi.org/10.1093/jac/dkx480
  15. Dany G. Kramer. (2022). Candida auris: A literature review | Tanzania Journal of Health Research. https://www.ajol.info/index.php/thrb/article/view/228399
  16. de Jong, A. W., Gerrits van den Ende, B., & Hagen, F. (2022). Molecular Tools for Candida auris Identification and Typing. Methods in Molecular Biology (Clifton, N.J.), 2517, 33–41. https://doi.org/10.1007/978-1-0716-2417-3_3
  17. Dekkerová, J., Černáková, L., Kendra, S., Borghi, E., Ottaviano, E., Willinger, B., & Bujdáková, H. (2022). Farnesol Boosts the Antifungal Effect of Fluconazole and Modulates Resistance in Candida auris through Regulation of the CDR1 and ERG11 Genes. Journal of Fungi, 8(8), 783. https://doi.org/10.3390/jof8080783
  18. Dixit, A. K., Marak, R. S. K., Bhartiya, C., Azim, A., Sahu, C., & Tripathi, S. (2022). P184 Candida auris candidemia in COVID-19 and post-COVID-19 patients in a tertiary care hospital in North India. Medical Mycology, 60(Suppl 1), myac072P184. https://doi.org/10.1093/mmy/myac072.P184
  19. Du, H., Bing, J., Hu, T., Ennis, C. L., Nobile, C. J., & Huang, G. (2020). Candida auris: Epidemiology, biology, antifungal resistance, and virulence. PLoS Pathogens, 16(10), e1008921. https://doi.org/10.1371/journal.ppat.1008921
  20. Forsberg, K., Woodworth, K., Walters, M., Berkow, E. L., Jackson, B., Chiller, T., & Vallabhaneni, S. (2019). Candida auris: The recent emergence of a multidrug-resistant fungal pathogen. Medical Mycology, 57(1), 1–12. https://doi.org/10.1093/mmy/myy054
  21. Frías-De-León, M. G., Hernández-Castro, R., Vite-Garín, T., Arenas, R., Bonifaz, A., Castañón-Olivares, L., Acosta-Altamirano, G., & Martínez-Herrera, E. (2020). Antifungal Resistance in Candida auris: Molecular Determinants. Antibiotics, 9(9), 568. https://doi.org/10.3390/antibiotics9090568
  22. Ghannoum, M., Arendrup, M. C., Chaturvedi, V. P., Lockhart, S. R., McCormick, T. S., Chaturvedi, S., Berkow, E. L., Juneja, D., Tarai, B., Azie, N., Angulo, D., & Walsh, T. J. (2020). Ibrexafungerp: A Novel Oral Triterpenoid Antifungal in Development for the Treatment of Candida auris Infections. Antibiotics, 9(9), 539. https://doi.org/10.3390/antibiotics9090539
  23. Giacobbe, D. R., Magnasco, L., Sepulcri, C., Mikulska, M., Koehler, P., Cornely, O. A., & Bassetti, M. (2021). Recent advances and future perspectives in the pharmacological treatment of Candida auris infections. Expert Review of Clinical Pharmacology, 14(10), 1205–1220. https://doi.org/10.1080/17512433.2021.1949285
  24. Hager, C. L., Larkin, E. L., Long, L. A., & Ghannoum, M. A. (2018). Evaluation of the efficacy of rezafungin, a novel echinocandin, in the treatment of disseminated Candida auris infection using an immunocompromised mouse model. Journal of Antimicrobial Chemotherapy, 73(8), 2085–2088. https://doi.org/10.1093/jac/dky153
  25. Hinrichs, C., Wiese‐Posselt, M., Graf, B., Geffers, C., Weikert, B., Enghard, P., Aldejohann, A., Schrauder, A., Knaust, A., Eckardt, K., Gastmeier, P., & Kurzai, O. (2022). Successful control of Candida auris transmission in a German COVID‐19 intensive care unit. Mycoses, 65(6), 643–649. https://doi.org/10.1111/myc.13443
  26. Jain, K., Shivarathri, R., Singh, A., Chauhan, N., & Chowdhary, A. (2022). P021 Comparative transcriptomic analysis of environmental Candida auris showing variable azole susceptibility. Medical Mycology, 60(Suppl 1), myac072P021. https://doi.org/10.1093/mmy/myac072.P021
  27. Jain, M., Jain, A., Khare, B., Jain, D. K., Khan, R., & Jain, D. (2022). An Update on the Recent Emergence of Candida auris. Asian Journal of Dental and Health Sciences, 2(1), 14–19. https://doi.org/10.22270/ajdhs.v2i1.11
  28. Jangir, P., Kalra, S., Tanwar, S., & Bari, V. K. (2023). Azole resistance in Candida auris: Mechanisms and combinatorial therapy. APMIS: Acta Pathologica, Microbiologica, et Immunologica Scandinavica, 131(8), 442–462. https://doi.org/10.1111/apm.13336
  29. Kamli, M. R., Sabir, J. S. M., Malik, M. A., & Ahmad, A. (2022). Characterization of Defensin-like Protein 1 for Its Anti-Biofilm and Anti-Virulence Properties for the Development of Novel Antifungal Drug against Candida auris. Journal of Fungi, 8(12), 1298. https://doi.org/10.3390/jof8121298
  30. Kilburn, S., Innes, G., Quinn, M., Southwick, K., Ostrowsky, B., Greenko, J. A., Lutterloh, E., Greeley, R., Magleby, R., Chaturvedi, V., & Chaturvedi, S. (2022). Antifungal Resistance Trends of Candida auris Clinical Isolates in New York and New Jersey from 2016 to 2020. Antimicrobial Agents and Chemotherapy, 66(3), e0224221. https://doi.org/10.1128/aac.02242-21
  31. Kordalewska, M., & Perlin, D. S. (2022). Detection and Identification of Candida auris from Clinical Skin Swabs. Methods in Molecular Biology (Clifton, N.J.), 2542, 245–256. https://doi.org/10.1007/978-1-0716-2549-1_18
  32. Maphanga, T. G., Naicker, S. D., Kwenda, S., Muñoz, J. F., van Schalkwyk, E., Wadula, J., Nana, T., Ismail, A., Coetzee, J., Govind, C., Mtshali, P. S., Mpembe, R. S., Govender, N. P., & for GERMS-SA. (2021). In Vitro Antifungal Resistance of Candida auris Isolates from Bloodstream Infections, South Africa. Antimicrobial Agents and Chemotherapy, 65(9), e0051721. https://doi.org/10.1128/AAC.00517-21
  33. Meyer, D., Martin, E. K., Madad, S., Dhagat, P., & Nuzzo, J. B. (2021). Preparedness and response to an emerging health threat-Lessons learned from Candida auris outbreaks in the United States. Infection Control and Hospital Epidemiology, 42(11), 1301–1306. https://doi.org/10.1017/ice.2021.12
  34. Moore, R., Lie, L., Pua, H., Slade, D. H., Rangel, S., Davila, A., Carson, J. S., & Parada, J. P. (2022). 1225. The Perfect Storm: A Hardy and Lethal Pathogen and a Unit Filled with Immunocompromised Patients with Large Open Wounds. Troubles with Candida auris in a Burn Intensive Care Unit. Open Forum Infectious Diseases, 9(Suppl 2), ofac492.1057. https://doi.org/10.1093/ofid/ofac492.1057
  35. Narayanan, A., Selvakumar, P., Siddharthan, R., & Sanyal, K. (2022). ClaID: A Rapid Method of Clade-Level Identification of the Multidrug Resistant Human Fungal Pathogen Candida auris. Microbiology Spectrum, 10(2), e00634-22. https://doi.org/10.1128/spectrum.00634-22
  36. Pezzotti, G., Kobara, M., Nakaya, T., Imamura, H., Fujii, T., Miyamoto, N., Adachi, T., Yamamoto, T., Kanamura, N., Ohgitani, E., Marin, E., Zhu, W., Kawai, T., Mazda, O., Nakata, T., & Makimura, K. (2022). Raman Metabolomics of Candida auris Clades: Profiling and Barcode Identification. International Journal of Molecular Sciences, 23(19), 11736. https://doi.org/10.3390/ijms231911736
  37. Prayag, P. S., Patwardhan, S., Panchakshari, S., Rajhans, P. A., & Prayag, A. (2022). The Dominance of Candida auris: A Single-center Experience of 79 Episodes of Candidemia from Western India. Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 26(5), 560–563. https://doi.org/10.5005/jp-journals-10071-24152
  38. Ravichandran, S., Shanmugam, P., & Thayikkannu, A. B. (2022). Phenotypic and Genotypic Characterization of Candida auris, an Emerging Pathogen Isolated from Blood. Journal of Communicable Diseases (E-ISSN: 2581-351X & P-ISSN: 0019-5138), 54(4), Article 4.
  39. Rybak, J. M., Cuomo, C. A., & Rogers, P. D. (2022). The molecular and genetic basis of antifungal resistance in the emerging fungal pathogen Candida auris. Current Opinion in Microbiology, 70, 102208. https://doi.org/10.1016/j.mib.2022.102208
  40. Shah, M. S., Hansora, S., & Shah, A. (2022). Resistant invasive Candida auris reported in neutropenic patients treated successfully with three antifungals. Indian Journal of Case Reports, 268–270. https://doi.org/10.32677/ijcr.v8i8.3577
  41. Tamura, T., Alshahni, M. M., & Makimura, K. (2022). Evaluation of CHROMagarTM Candida Plus chromogenic agar for the presumptive identification of Candida auris. Microbiology and Immunology, 66(6), 292–298. https://doi.org/10.1111/1348-0421.12973
  42. Victor Garcia-Bustos. (2021). Microorganisms | Free Full-Text | What Do We Know about Candida auris? State of the Art, Knowledge Gaps, and Future Directions. https://www.mdpi.com/2076-2607/9/10/2177
  43. Watkins, R. R., Gowen, R., Lionakis, M. S., & Ghannoum, M. (2022). Update on the Pathogenesis, Virulence, and Treatment of Candida auris. Pathogens and Immunity, 7(2), 46–65. https://doi.org/10.20411/pai.v7i2.535
  44. Xin, H., Rosario-Colon, J. A., & Eberle, K. (2023). Novel Intravenous Immunoglobulin Therapy for the Prevention and Treatment of Candida auris and Candida albicans Disseminated Candidiasis. mSphere, 8(1), e00584-22. https://doi.org/10.1128/msphere.00584-22
  45. Zamith-Miranda, D., Heyman, H. M., Cleare, L. G., Couvillion, S., Clair, G., Bredeweg, E., Gacser, A., Nimrichter, L., Nakayasu, E. S., & Nosanchuk, J. D. (2019). Candida auris: Multi-omics signature of an emerging and multidrug-resistant pathogen. https://doi.org/10.1101/528232
  46. Zhou, W., Li, X., Lin, Y., Yan, W., Jiang, S., Huang, X., Yang, X., Qiao, D., & Li, N. (2021). A Comparative Transcriptome Between Anti-drug Sensitive and Resistant Candida auris in China. Frontiers in Microbiology, 12, 708009. https://doi.org/10.3389/fmicb.2021.708009