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| This is the sentence to cite.<ref name=cdc1>Centers for Disease Control and Prevention. https://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-alert.html Accessed on November 11th, 2016. </ref>
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| Therefore it is important that any Candida spp isolates associated with invasive infections and isolates from superficial sites in patients from high intensity settings and those transferred from an affected hospital (UK or abroad) should be analysed to species level. If Candida haemulonii, Candida famata, Candida sake or Saccharomyces cerevisiae are identified, further work should be undertaken to ensure that they are not C. auris. This would involve either molecular sequencing of the D1/D2 domain or MALDI-TOF Biotyper analysis with C. auris either already present or added to the database.<ref name=cdc2>Public Health England.https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/534174/Guidance_Candida__auris.pdf. Accessed on November 11th, 2016.</ref>
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| According to published data, commercially available biochemical-based tests, including API AUX 20C and VITEK-2 YST, used in many front line diagnostic laboratories can misidentify C. auris as Candida haemulonii, Saccharomyces cerevisiae or Rhodotorula glutini.<ref name="cdc2" />
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| Therefore, it is important that any Candida spp. isolates associated with invasive infections and isolates from superficial sites in patients from high intensity settings and those transferred from an affected hospital (UK or abroad) should be analysed to species level. As knowledge on the epidemiology and prevalence in the UK is as yet limited, PHE is currently not in a position to make specific recommendations with regards to screening policy. However, C. auris screening could be considered for patients at risk for Candida disease (ESCMID guidance developing group define such patients as “[…] mainly ICU patients, paediatric, HIV/AIDS and patients with malignancies including haematopoietic stem cell transplantation.”)<ref name="pmidRef: HPR 10(21)">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=Ref: HPR 10(21) | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref>
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| Since April 2015, an adult critical care unit in England has been managing an outbreak of C. auris, with more than 40 patients either colonised or infected; approximately 20% with candidaemia. The hospital outbreak has been difficult to control, despite enhanced infection control interventions, including regular patient screening, environmental decontamination and ward closure<ref name="pmidRef: HPR 10(21)" />
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| C. auris, on microscopy, is indistinguishable from most other Candida species, it is a germ tube test negative budding yeast, however some strains can form rudimentary pseudohyphae on cornmeal agar. Most C. auris isolates are a pale purple or pink colour on the chromogenic agar, CHROMagar Candida, in common with several other non C. albicans species. Growth on this and other chromogenic agars (which may display a different colour) cannot be used as a primary identification method. Chromogenic agars are useful to identify mixed cultures including the presence of C. albicans. If there is evidence of non - albicans on chromogenic agar these should be sub-cultured on Sabouraud’s agar and identified according to local laboratory protocols. It is unlikely that any of the currently available biochemical-based tests will include C. auris in their database as it is a newly recognised species so laboratories are advised to check the databases provided for their current methods. According to published data, commercially available biochemical-based tests, including API AUX 20C and VITEK-2 YST, used in many front line diagnostic laboratories can misidentify C. auris as Candida haemulonii, Saccharomyces cerevisiae or Rhodotorula glutinis (the latter species is pink on Sabouraud’s agar and is easily distinguished). Therefore it is important that any Candida spp isolates associated with invasive infections and isolates from superficial sites in patients from high intensity settings and those transferred from an affected hospital (UK or abroad) should be analysed to species level. If Candida haemulonii, Candida famata, Candida sake or Saccharomyces cerevisiae are identified, further work should be undertaken to ensure that they are not C. auris. This would involve either molecular sequencing of the D1/D2 domain or MALDI-TOF Biotyper analysis with C. auris either already present or added to the database.<ref name="cdc2" />
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| Antifungal susceptibility testing: There are no established minimum inhibitory concentration (MIC) breakpoints at present for C. auris. Using breakpoints for other Candida spp the Centers for Disease Control and Prevention (CDC) demonstrated that of the global outbreaks that they have been investigating, nearly all isolates are highly resistant to fluconazole. In their analysis, more than half of C. auris isolates were resistant to voriconazole, one- third were resistant to amphotericin B (MIC ≥2 mg/L), and a few were resistant to echinocandins. Some isolates have demonstrated elevated MICs to all three major antifungal classes, including azoles, echinocandins, and polyenes indicating that treatment options would be limited. Whole genome sequencing of the organism has found resistant determinants to a variety of antifungal agents. <ref name="cdc2" />
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| '''Candida auris Microchapters'''
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| [[Candida auris (patient information)|'''Patient Information''']]
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| [[Candida auris overview|'''Overview''']]
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| [[Candida auris historical perspective|'''Historical Perspective''']]
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| !'''Microbiology'''
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| [[Candida auris pathophysiology|'''Pathophysiology''']]
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| [[Candida auris differential diagnosis|'''Differentiating Candida auris infection from other Diseases''']]
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| [[Candida auris epidemiology and demographics|'''Epidemiology and Demographics''']]
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| [[Candida auris risk factors|'''Risk Factors''']]
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| [[Candida auris screening|'''Screening''']]
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| [[Candida auris natural history, complications and prognosis|'''Natural History, Complications and Prognosis''']]
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| '''Diagnosis'''
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| [[Candida auris history and symptoms|'''History and Symptoms''']]
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| [[Candida auris clinical presentation|'''clinical presentation''']]
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| [[Candida auris laboratory findings|'''Laboratory Findings''']]
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| [[Candida auris x ray findings | '''X Ray''']]
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| [[Candida auris CT| '''CT''']]
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| [[Candida auris other imaging findings| '''Other Imagining Findings''']]
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| [[Candida auris other diagnostic studies|'''Other Diagnostic Studies''']]
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| '''Treatment'''
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| [[Candida auris medical therapy|'''Medical Therapy''']]
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| [[Candida auris surgery|'''Surgery''']]
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| [[Candida auris primary prevention|'''Primary Prevention''']]
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| [[Candida auris secondary prevention|'''Secondary Prevention''']]
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| [[Candida auris cost-effectiveness of therapy|'''Cost-Effectiveness of Therapy''']]
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| [[Candida auris future or investigational therapies|'''Future or Investigational Therapies''']]
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| '''Case Studies'''
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| [[Candida auris case study one|'''Case #1''']]
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| '''{{PAGENAME}} On the Web'''
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| [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&db=pubmed&term={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}} '''Most recent articles''']
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| [http://scholar.google.com/scholar?ie=UTF-8&oe=utf-8&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}&qt_s=Search&sa=N&tab=ps '''Most cited articles''']
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| [http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&term={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}%20AND%20systematic%5Bsb%5D '''Review articles''']
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| :[http://goldminer.arrs.org/search.php?query={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}} '''All Images''']
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| :[http://goldminer.arrs.org/search.php?query={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}} X-ray}}}} '''X-rays''']
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| :[http://goldminer.arrs.org/search.php?query={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}} Ultrasound}}}} '''Echo & Ultrasound''']
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| [http://clinicaltrials.gov/search/open/condition={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}} '''Ongoing Trials at Clinical Trials.gov''']
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| [http://www.guideline.gov/search/searchresults.aspx?Type=3&txtSearch={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}&num=20 '''US National Guidelines Clearinghouse''']
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| ==Overview of Candida auris==
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| Candida auris is a fungus, recently described as a rare cause of fungal infection with significant resistance to antifungal medications.<ref name="pmid24357342">{{cite journal| author=Chowdhary A, Anil Kumar V, Sharma C, Prakash A, Agarwal K, Babu R et al.| title=Multidrug-resistant endemic clonal strain of Candida auris in India. | journal=Eur J Clin Microbiol Infect Dis | year= 2014 | volume= 33 | issue= 6 | pages= 919-26 | pmid=24357342 | doi=10.1007/s10096-013-2027-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24357342 }} </ref> Candida auris isolates from north and south Indian hospitals, Japan and Korea were all found to be resistant to the antifungal medication fluconazole.<ref name="pmid24357342></ref> Some isolates were also noted to be resistant to flucytosine and voriconazole.<ref name="pmid24357342></ref> The high rate of therapeutic failure noted in cases of Candida auris fungemia poses significant concerns.<ref name="pmid24357342></ref> It's high potential for nosocomial horizontal transmission has been demonstrated.<ref name="pmid27452195">{{cite journal| author=Calvo B, Melo AS, Perozo-Mena A, Hernandez M, Francisco EC, Hagen F et al.| title=First report of Candida auris in America: Clinical and microbiological aspects of 18 episodes of candidemia. | journal=J Infect | year= 2016 | volume= 73 | issue= 4 | pages= 369-74 | pmid=27452195 | doi=10.1016/j.jinf.2016.07.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27452195 }} </ref><ref name="pmid27777756">{{cite journal| author=Schelenz S, Hagen F, Rhodes JL, Abdolrasouli A, Chowdhary A, Hall A et al.| title=First hospital outbreak of the globally emerging Candida auris in a European hospital. | journal=Antimicrob Resist Infect Control | year= 2016 | volume= 5 | issue= | pages= 35 | pmid=27777756 | doi=10.1186/s13756-016-0132-5 | pmc=5069812 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27777756 }}</ref>An outbreak of fifty cases over a sixteen month period (April 2015-July2016) in a cardiothoracic center in London is the first reported case, and the largest outbreak in Europe.<ref name="pmid27777756"></ref> It is recognized as a globally emerging fungal pathogen<ref name="pmid27777756"></ref>.
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| ==Historical Perspective==
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| ==References==
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| {{Reflist|2}}
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