Managing Candida auris in dialysis units: challenges, strategies, and future directions

Candida auris (C. auris) is an emerging fungal pathogen responsible for numerous nosocomial outbreaks worldwide over the past decade. Its resistance to multiple antifungal agents poses a significant challenge in clinical management. In addition, high rates of misdiagnosis and its ability to form biofilms further complicate treatment and control efforts. Immunocompromised patients, particularly those with chronic diseases or invasive medical devices, are at heightened risk. Despite its global prevalence, the true extent of C. auris infections remains uncertain due to several diagnostic challenges. Notably, limited availability of specialized molecular diagnostic tools in resource-limited settings exacerbates the underreporting of infections, leaving the full scope of its impact largely undetected.

To investigate the prevalence and impact of C. auris on hemodialysis patients, as well as methods for prevention and management of C. auris infections in hemodialysis units.

This review synthesizes data from peer-reviewed journals and clinical studies addressing C. auris epidemiology, diagnostic challenges, resistance patterns, and infection management, with a focus on patients with chronic kidney failure. Data on biofilm behavior, antifungal efficacy, and infection control practices in hemodialysis environments were analyzed to identify existing knowledge gaps.

Candida auris infections occur more frequently in males (≈60%) and individuals over 65 years of age. The pathogen colonizes various anatomical sites and thrives in hospital settings, withstanding temperatures up to 42 °C and salinity levels up to 3%. Diagnostic errors are frequent: conventional biochemical methods misidentify up to 40% of cases, while molecular diagnostics offer ≥ 95% specificity. Existing antifungal lock solutions show limited effectiveness (50-60%), whereas hemodialysis patients are 3-4 times more likely to develop bloodstream infections due to the use of central venous catheters. Novel experimental antifungal combinations yield > 80% eradication rates in preclinical settings.

Candida auris presents a significant threat to hemodialysis patients due to its resilience, misdiagnosis rates, and treatment resistance. Actionable recommendations include implementing molecular diagnostics in high-risk settings, developing targeted antifungal lock protocols, and enhancing surface decontamination practices in dialysis units to prevent biofilm formation and pathogen transmission.