Identification of Candida auris (C. auris)

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Identification of Candida auris (C. auris)

Key Information

Candida auris  is a multidrug-resistant yeast that requires accurate laboratory identification and mandatory public health reporting. Confirmed cases should be reported to local/state health authorities.

Laboratory Appearance & Growth Characteristics

  • On CHROMagar, colonies may appear white or pink, sometimes red or purple
  • Forms a budding yeast, rarely producing short pseudohyphae
  • Does not form germ tubes
  • Some strains form cell aggregates, others do not
  • Grows well at 40–42°C, unlike most Candida species

When to Suspect C. auris

  • Increase in unidentified Candida infections in healthcare units
  • Rising isolation of Candida from urine specimens
  • Suspected nosocomial transmission patterns
  • C. auris can be misidentified as a number of different organisms when using traditional phenotypic methods for yeast identification.:
    • VITEK 2 YST
    • API 20C
    • BD Phoenix
    • MicroScan

⚠️ requiring confirmatory testing.

Culture-Based Identification Clues

  • Colony color alone is not diagnostic
  • Must combine morphology with advanced identification methods
  • New chromogenic media may improve detection but are not definitive

MALDI-TOF Identification

Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) systems can identify C. auris if updated databases are used.


Molecular Identification Methods

  • Sequencing targets.
  • FDA-approved blood culture molecular tests.

PCR-Based Testing

  • No FDA-approved high-throughput colonization PCR tests currently exist
  • Available PCR methods vary in:
    • Sensitivity and specificity
    • Turnaround time
    • Laboratory capacity requirements
  • Validation should consider clinical sample type performance

Limitations of Routine Systems

  • Phenotypic systems (e.g., Vitek 2) may miss or misidentify certain C. auris clades
  • All isolates in the Candida haemulonii complex should be further evaluated

Referral & Public Health Testing

  • Suspected isolates should be sent to:
    • State public health central laboratories
  • Testing includes:
    • Species confirmation
    • Antifungal susceptibility testing .
  • Sample handling:
    • Ship at room temperature
    • Use blood or chocolate agar slants
    • Specialized mycology media not required

Colonization Testing

  • In-house testing is possible with validated methods
  • Follow  the recommended guidance for:
    • Detection of colonization
    • Processing of surveillance swabs

Public Health Action

  • All confirmed cases require:
    • Immediate public health notification
    • Coordination with state specific programs
    • Potential referral to central laboratories for confirmation

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