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| Candida auris infections are difficult to treat and potentially life-threatening. The picture shows yeast cells from C. auris on the left and a fluconazole-resistant C. auris strain on the right. Image Credit: Alexander Aldejohann |
In Germany, too, the number of infections with the Candida auris fungus is increasing. This is shown by a new study by research teams from Würzburg, Jena and Berlin. Despite the low numbers, those involved advise precautionary measures.
Among the yeasts from the genus Candida, that cause infections in humans is the type Candida auris still relatively new: this species was only described in 2009, and no evidence is known before the 1990s. It is unclear which ecological niche C. auris populated and why human infections have increased since the turn of the millennium.
The treatment of C. auris infections are made considerably more difficult by the potential of the pathogen to develop resistance to all available antifungals classes. In addition, C. auris unlike others Candida- Types, are efficiently transmitted from patient to patient via direct and indirect contact, thus leading to hospital outbreaks that are difficult to control.
Dramatic increase in the United States
Such outbreaks have now been observed worldwide, including in England, Spain and Italy. In April 2023, the United States saw a dramatic increase in C. auris-Infections and at the same time a further development of resistance shown. A current analysis of the European Center for Disease Prevention and Control (ECDC) also shows a significant increase in the number of cases for Europe.
Therefore, the American Centers for Disease Control classify C. auris as a "urgent threat" - the highest prioritization category within the multi-resistant pathogens. Also, in the list published by the World Health Organization 2023 on the prioritization of fungi that cause human infections C. auris grouped as one of only four pathogens in the highest priority level.
Fall figures also increase in Germany
In Germany there have only been individual cases since 2015 in which C. auris what proven. However, an analysis now published in the German Medical Journal shows that the number of cases has also increased in Germany in recent years. Dr. was responsible for this study. Alexander Aldejohann from the Institute for Hygiene and Microbiology at the Julius Maximilians University in Würzburg (JMU) as well as scientists from the National Reference Center for Invasive Fungal Infections (NRZMyk) and the Robert Koch Institute (RKI). The course was headed by Professor Oliver Kurzai, director of the Institute for Hygiene and Microbiology and head of the NRZMyk.
The study is based on a comparison of C. auris-Data from the NRZMyk and the antibiotic resistance surveillance network of the Robert Koch Institute. By the end of 2022, a total of 43 were recorded in the two databases C. auris-Cases. Colonization was demonstrated in 19 cases and infection requiring therapy in 16 cases. In almost 42 percent of the cases, a stay abroad was known shortly before proof of infection.
Resistant to common drugs
80 percent of the fungal strains available at NRZMyk were highly resistant to fluconazole, a common anti-fungal agent. In one case there was resistance to Echinocandin, a comparatively new class of substances for the treatment of fungal infections. The data analysis also recorded probable nosocomial transmissions in Germany for 2021 and 2022 - i.e. infection that patients had contracted in connection with a medical measure, for example in hospitals, nursing facilities or in outpatient practices.
In summary, the authors come to the conclusion that the absolute number of cases C. auris-Infections in Germany are still low. In their view, however, the significant increase in evidence of infection over the past two years and the detection of the first transmission events in Germany should be seen as an alarm signal.
Voices for publication
“Fortunately, the number of cases with us is still low compared to other European countries such as Spain, Italy or Great Britain. We have to do everything to keep it as long as possible - our experience shows that every infection with Candida auris is difficult to treat and potentially life-threatening for patients. The good news is up to date: No patient in a German hospital has to be afraid to join Candida auris to infect." (Dr. A. Aldejohann, specialist in microbiology, virology and infection epidemiology, Institute for Hygiene and Microbiologist, University of Würzburg)
“Fortunately, our analyzes still show a significant increase in the level - at a very low-level C. auris-Imports to Germany. At the same time, we were able to demonstrate that the cases are currently not fully recorded in any database - we have to assume a number of unreported cases. In view of the fact that we are already finding the first transmission events in Germany, I have introduced the Robert Koch Institute to introduce a legal laboratory reporting requirement for the detection of C. auris recommended. In my view, this can be implemented with reasonable effort and, in addition to a precise recording of epidemiology, would also make it possible to initiate infection protection measures at an early stage if evidence is provided." (Prof. Dr. Oliver Kurzai, Chair of Medical Microbiology and Mycology, University of Würzburg and Head, NRZMyk)
Published in journal: Aerzteblatt
Source/Credit: University of Würzburg
Reference Number: mcb051223_01
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