Candida auris: Multidrug resistance and new treatment strategies

Main Article Content

Elisa Cardoso Bensusan
Julia Araujo Soares
Leandro Giorgetti
Pãmella Antunes de Macêdo-Sales

Abstract

Candida auris is an emerging public health threat fungal pathogen of high virulence and mortality rates throughout the world causing outbreaks in hospitals, hence it has become both an unfathomable and challenging nosocomial infection. The prevalence of this yeast infection is mostly seen in immunocompromised patients admitted to intensive care units in use of antibiotics, immunosuppressive drugs and catheters. As it exhibits an amplified resistance to recurrent antifungal drugs, along with its delayed diagnostic rates due to its similarities to other Candida species, in addition to how quickly it spreads, this pathogen takes part in a major concern within healthcare centers. C. auris’ high virulence is mainly on account of the biofilm formation in medical devices as a consequence of its phenotypic plasticity and ability to adapt to the most challenging and fraught conditions remaining viable in innumerable surfaces for up to two weeks. A better understanding of those aspects is imperative in order to control and provide alternative treatment strategies. In light of this, the aim of this study was to systematically investigate publications related to C. auris' relevance, focusing on the epidemiological strains prevalent all over the world, not only as a nosocomial rising infection and its concern in global public health, but also focus on its resistance mechanisms to available antifungal treatment in addition to propose future investigation on new promising treatment strategies.

Article Details

How to Cite
Cardoso Bensusan, E., Araujo Soares, J. ., Giorgetti, L. ., & Antunes de Macêdo-Sales, P. . (2022). Candida auris: Multidrug resistance and new treatment strategies . Brazilian Journal of Biomedical Sciences, 3(1), E0682022 – 1. https://doi.org/10.46675/rbcbm.v3i1.68
Section
Review article
Author Biographies

Elisa Cardoso Bensusan, Anhembi Morumbi (UAM), São Paulo, Brazil

Undergraduate Pharmacy student, Escola de Ciências da Saúde da Universidade Anhembi Morumbi (UAM), São Paulo, Brazil

Julia Araujo Soares, Universidade Anhembi Morumbi

Graduanda do curso de Farmácia da Universidade Anhembi Morumbi , Analista de Validação Jr.  atuanddo na qualificação de equipamentos · Validação de sistemas computadorizados · Plano mestre de validação · Atividades de integração de equipe.

Leandro Giorgetti, Universidade Anhembi Morumbi

Mestre em Fármaco e Medicamentos pela Universidade de São Paulo. Atua nas áreas de pré-formulação, formulação, estabilidade e dissolução de formas farmacêuticas sólidas. Como Analista Farmacêutico do Laboratório de Desenvolvimento e Inovação Farmacotécnica (DEINFAR - FCF/USP) gerenciou projetos de parceria entre iniciativa privada e universidades públicas, sendo responsável pela elaboração de todos os relatórios de resultados. Paralelamente, também adquiriu experiência na docência de graduação, atuando na área até hoje e tendo como ocupação o cargo de Professor no Curso de Farmácia da Universidade Anhembi-Morumbi, lecionando as disciplinas de Química Analítica, Físico-Química, Tecnologia Farmacêutica e Trabalho de Conclusão de Curso em Farmácia.

Pãmella Antunes de Macêdo-Sales, Universidade Estácio de Sá

Graduada em Biomedicina com habilitação em Análises Clínicas pelo Centro Universitário Plínio Leite (2010), mestre em Microbiologia e Parasitologia Aplicadas pela Universidade Federal Fluminense (2014) e doutora pelo mesmo Programa de pós-graduação (2019). Realizou doutorado sanduíche na Universidad de Guanajuato (México, 2018/2019). Tem experiência em Microbiologia, com ênfase em Microbiologia Médica, atuando principalmente nos seguintes temas: boas práticas de laboratório, micologia médica e veterinária, utilização de modelo invertebrado para experimentação in vivo, diagnóstico micológico clássico e molecular.

References

. Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiology and Immunology. 2009 Jan;53(1):41–4.

. AlJindan R, AlEraky DM. Silver Nanoparticles: A Promising Antifungal Agent against the Growth and Biofilm Formation of the Emergent Candida auris. Journal of Fungi. 2022 Jul 19;8(7):744.

. Horton MV, Nett JE. Candida auris Infection and Biofilm Formation: Going Beyond the Surface. Current Clinical Microbiology Reports. 2020 Jul 17;7(3):51–6.

. Centers for Disease Control and Prevention (CDC). Tracking Candida auris. July 21, 2022. Available at: https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html Accessed November 1st. 2022.

. Sanyaolu A, Okorie C, Marinkovic A, Abbasi AF, Prakash S, Mangat J, et al. Candida auris: An Overview of the Emerging Drug-Resistant Fungal Infection. Infection & Chemotherapy. 2022;54(2):236.

. Chakrabarti A, Sood P. On the emergence, spread and resistance of Candida auris: host, pathogen and environmental tipping points. Journal of Medical Microbiology. 2021 Mar 1;70(3).

. Simm C, Weerasinghe H, Thomas DR, Harrison PF, Newton HJ, Beilharz TH, et al. Disruption of Iron Homeostasis and Mitochondrial Metabolism Are Promising Targets to Inhibit Candida auris. Vylkova S, editor. Microbiology Spectrum. 2022 Apr 27;10(2).

. Giacobbe DR, Magnasco L, Sepulcri C, Mikulska M, Koehler P, Cornely OA, et al. Recent advances and future perspectives in the pharmacological treatment of Candida auris infections. Expert Review of Clinical Pharmacology. 2021 Jul 15;14(10):1205–20.

. Kwon YJ, Shin JH, Byun SA, Choi MJ, Won EJ, Lee D, et al. Candida auris Clinical Isolates from South Korea: Identification, Antifungal Susceptibility, and Genotyping. Land GA, editor. Journal of Clinical Microbiology. 2019 Feb 6;57(4).

. Ruiz GB, Lorenz A. What do we know about the biology of the emerging fungal pathogen of humans Candida auris? Microbiological Research. 2020 Oct;126621.

. Chow NA, de Groot T, Badali H, Abastabar M, Chiller TM, Meis JF. Potential Fifth Clade of Candida auris, Iran, 2018. Emerging Infectious Diseases. 2019 Sep;25(9).

. Chybowska AD, Childers DS, Farrer RA. Nine Things Genomics Can Tell Us About Candida auris. Frontiers in Genetics. 2020 Apr 15;11.

. Fernandes L, Ribeiro R, Henriques M, Rodrigues ME. Candida auris, a singular emergent pathogenic yeast: its resistance and new therapeutic alternatives. European Journal of Clinical Microbiology & Infectious Diseases. 2022 Oct 6;41(12):1371–85.

. Casadevall A, Kontoyiannis DP, Robert V. On the Emergence of Candida auris: Climate Change, Azoles, Swamps, and Birds. Kronstad JW, editor. mBio. 2019 Jul 23;10(4).

. Agência Nacional de Vigilância Sanitária - ANVISA. Alerta de Risco GVIMS/GGTES/Anvisa no 01/2022 (11/01/2022) - Confirmação de novo caso de Candida auris no Brasil. Available from:https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/comunicados-de-risco-1/alerta-de-risco-gvims-ggtes-anvisa-no-01-2022/view. Accessed on November 1st.

. United States Environmental Protection Agency - EPA. List P: Antimicrobial Products Registered with EPA for Claims Against Candida Auris. Available from: https://www.epa.gov/pesticide-registration/list-p-antimicrobial-products-registered-epa-claims-against-candida-auris. Accessed on November 1st.

. Allert S, Schulz D, Kämmer P, Großmann P, Wolf T, Schäuble S, et al. From environmental adaptation to host survival: Attributes that mediate pathogenicity of Candida auris. Virulence. 2022 Feb 10;13(1):191–214.

. Bravo Ruiz G, Ross ZK, Gow NAR, Lorenz A. Pseudohyphal Growth of the Emerging Pathogen Candida auris Is Triggered by Genotoxic Stress through the S Phase Checkpoint. Mitchell AP, editor. mSphere. 2020 Mar 11;5(2).

. Huang X, Welsh RM, Deming C, Proctor DM, Thomas PJ, Gussin GM, et al. Skin Metagenomic Sequence Analysis of Early Candida auris Outbreaks in U.S. Nursing Homes. Young VB, editor. mSphere. 2021 Aug 25;6(4).

. O’Meara TR. Metagenomic Sequencing for Direct Identification of Candida auris Colonization. mSphere. 2021 Aug 25;6(4).

. Maslo C, du Plooy M, Coetzee J. The efficacy of pulsed-xenon ultraviolet light technology on Candida auris. BMC Infectious Diseases. 2019 Jun 19;19(1).

. Bandara HMHN, Samaranayake LP. Emerging strategies for environmental decontamination of the nosocomial fungal pathogen Candida auris. Journal of Medical Microbiology. 2022 Jun 10;71(6).

. Izadi A, Aghaei Gharehbolagh S, Sadeghi F, Talebi M, Darmiani K, Zarrinnia A, et al. Drug repurposing against Candida auris : A systematic review. Mycoses. 2022 Jun 19;65(8):784–93.

. Abduljalil H, Bakri A, Albashaireh K, Alshanta OA, Brown JL, Sherry L, et al. Screening the TocriscreenTM bioactive compound library in search for inhibitors of Candida biofilm formation. APMIS. 2022 Jul 20;130(9):568–77.

. de Oliveira HC, Castelli RF, Reis FCG, Samby K, Nosanchuk JD, Alves LR, et al. Screening of the Pandemic Response Box Reveals an Association between Antifungal Effects of MMV1593537 and the Cell Wall of Cryptococcus neoformans , Cryptococcus deuterogattii , and Candida auris. Nielsen K, editor. Microbiology Spectrum. 2022 Jun 29;10(3).

. Orofino F, Truglio GI, Fiorucci D, D’Agostino I, Borgini M, Poggialini F, et al. In vitro characterization, ADME analysis, and histological and toxicological evaluation of BM1, a macrocyclic amidinourea active against azole-resistant Candida strains. International Journal of Antimicrobial Agents. 2020 Mar;55(3):105865.

. NE Azie , TR King, T Chen, DA Angulo. Outcomes of Oral Ibrexafungerp in the Treatment of 18 Patients with Candida auris Infections, from the CARES Study SCYNEXIS Inc., Jersey City, NJ. October 2021. Available from: https://www.scynexis.com/science/publications-and-presentations/posters-and-presentations

. RS Siebert, D Juneja, O Singh, B Tarai2, C Ross, RC Reuben, J Breedt, N Yaddanapudi, M Conradie, F Mahmood , S Sanchez, TR King, NE Azie, DA Angulo. Outcomes of Oral Ibrexafungerp in the Treatment of 18 Patients with Candida auris Infections, from the CARES Study SCYNEXIS, Inc., Jersey City, NJ. April 2022. Available from: https://www.scynexis.com/science/publications-and-presentations/posters-and-presentations

. Chu S, Long L, Sherif R, McCormick TS, Borroto-Esoda K, Barat S, et al. A Second-Generation Fungerp Analog, SCY-247, Shows Potent In Vitro Activity against Candida auris and Other Clinically Relevant Fungal Isolates. Antimicrobial Agents and Chemotherapy. 2021 Feb 17;65(3).

. Hager CL, Larkin EL, Long L, Abidi FZ, Shaw KJ, Ghannoum MA. In Vitro and In Vivo Evaluation of the Antifungal Activity of APX001A/APX001 against Candida auris. Antimicrobial Agents and Chemotherapy [Internet]. 2018 Mar 1 [cited 2021 Mar 15];62(3). Available from: https://aac.asm.org/content/62/3/e02319-17.long.

. Arendrup MC, Chowdhary A, Jørgensen KM, Meletiadis J. Manogepix (APX001A) In Vitro Activity against Candida auris: Head-to-Head Comparison of EUCAST and CLSI MICs. Antimicrobial Agents and Chemotherapy. 2020 Sep 21;64(10).

. Wiederhold NP, Najvar LK, Jaramillo R, Olivo M, Patterson H, Connell A, et al. The Novel Arylamidine T-2307 Demonstrates In Vitro and In Vivo Activity against Candida auris. Antimicrobial Agents and Chemotherapy. 2020 Feb 21;64(3).

. Liu L, Zhang X, Kayastha S, Tan L, Zhang H, Tan J, et al. A Preliminary in vitro and in vivo Evaluation of the Effect and Action Mechanism of 17-AAG Combined With Azoles Against Azole-Resistant Candida spp. Frontiers in Microbiology. 2022 Jul 7;13.

. Sun N, Li D, Zhang Y, Killeen K, Groutas W, Calderone R. Repurposing an inhibitor of ribosomal biogenesis with broad anti-fungal activity. Scientific Reports. 2017 Dec;7(1).

. Nagy F, Vitális E, Jakab Á, Borman AM, Forgács L, Tóth Z, et al. In vitro and in vivo Effect of Exogenous Farnesol Exposure Against Candida auris. Frontiers in Microbiology. 2020 May 20;11.

. Barreto TL, Rossato L, de Freitas ALD, Meis JF, Lopes LB, Colombo AL, et al. Miltefosine as an alternative strategy in the treatment of the emerging fungus Candida auris. International Journal of Antimicrobial Agents [Internet]. 2020 Aug 1;56(2):106049. Available from: https://pubmed.ncbi.nlm.nih.gov/32544569/

. Gowri M, Jayashree B, Jeyakanthan J, Girija EK. Sertraline as a promising antifungal agent: inhibition of growth and biofilm of Candida auris with special focus on the mechanism of action in vitro. Journal of Applied Microbiology [Internet]. 2020 Feb 1 [cited 2021 Apr 15];128(2):426–37. Available from: https://pubmed.ncbi.nlm.nih.gov/31621139/

. Bugli F, Massaro F, Buonocore F, Saraceni PR, Borocci S, Ceccacci F, et al. Design and Characterization of Myristoylated and Non-Myristoylated Peptides Effective against Candida spp. Clinical Isolates. International Journal of Molecular Sciences. 2022 Feb 16;23(4):2164.

. Rather IA, Sabir JSM, Asseri AH, Ali S. Antifungal Activity of Human Cathelicidin LL-37, a Membrane Disrupting Peptide, by Triggering Oxidative Stress and Cell Cycle Arrest in Candida auris. Journal of Fungi. 2022 Feb 20;8(2):204.

. Kovács R, Nagy F, Tóth Z, Forgács L, Tóth L, Váradi G, et al. The Neosartorya fischeri Antifungal Protein 2 (NFAP2): A New Potential Weapon against Multidrug-Resistant Candida auris Biofilms. International Journal of Molecular Sciences. 2021 Jan 14;22(2):771.

. Cleare LG, Li KL, Abuzeid WM, Nacharaju P, Friedman JM, Nosanchuk JD. NO Candida auris: Nitric Oxide in Nanotherapeutics to Combat Emerging Fungal Pathogen Candida auris. Journal of Fungi. 2020 Jun 12;6(2):85.

. Kamli MR, Srivastava V, Hajrah NH, Sabir JSM, Hakeem KR, Ahmad A, et al. Facile Bio-Fabrication of Ag-Cu-Co Trimetallic Nanoparticles and Its Fungicidal Activity against Candida auris. Journal of Fungi. 2021 Jan 18;7(1):62.

. Fernandes L, Ribeiro R, Costa R, Henriques M, Rodrigues ME. Essential Oils as a Good Weapon against Drug-Resistant Candida auris. Antibiotics. 2022 Jul 20;11(7):977.

. Zhang F, Zhao M, Braun DR, Ericksen SS, Piotrowski JS, Nelson J, et al. A marine microbiome antifungal targets urgent-threat drug-resistant fungi. Science. 2020 Nov 20;370(6519):974–8.

. Paniágua AL, Correia AF, Pereira LC, de Alencar BM, Silva FBA, Almeida RM, et al. Inhibitory effects of Lactobacillus casei Shirota against both Candida auris and Candida spp. isolates that cause vulvovaginal candidiasis and are resistant to antifungals. BMC Complementary Medicine and Therapies. 2021 Sep 23;21(1).

. Kubiczek D, Flaig C, Raber H, Dietz S, Kissmann A, Heerde T, et al. A Cerberus‐Inspired Anti‐Infective Multicomponent Gatekeeper Hydrogel against Infections with the Emerging “Superbug” Yeast Candida auris. Macromolecular Bioscience. 2020 Feb 27;20(4):2000005.

. de Groot T, Janssen T, Faro D, Cremers NAJ, Chowdhary A, Meis JF. Antifungal Activity of a Medical-Grade Honey Formulation against Candida auris. Journal of Fungi. 2021 Jan 13;7(1):50.

. Ghannoum M, Arendrup MC, Chaturvedi VP, Lockhart SR, McCormick TS, Chaturvedi S, et al. Ibrexafungerp: A Novel Oral Triterpenoid Antifungal in Development for the Treatment of Candida auris Infections. Antibiotics. 2020 Aug 25;9(9):539.

. Spadari C de C, de Bastiani FWM da S, Lopes LB, Ishida K. Alginate nanoparticles as non-toxic delivery system for miltefosine in the treatment of candidiasis and cryptococcosis. International Journal of Nanomedicine. 2019 Jul;Volume 14:5187–99.