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Diagnostic Approaches for Candida auris: A Comprehensive Review of Screening, Identification, and Susceptibility
Christine Hsu1,2, Mohamed Yassin3
1College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan.
Abstract:
Candida auris (C. auris) is an emerging multidrug-resistant fungal pathogen recognized by the World Health Organization (WHO) as a critical global health threat. Its rapid transmission, high mortality rate, and frequent misidentification in clinical laboratories present significant challenges for diagnosis and infection control. This review provides a comprehensive overview of current and emerging diagnostic methods for C. auris detection, including culture-based techniques, biochemical assays, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and molecular diagnostics such as PCR and loop-mediated isothermal amplification (LAMP). We evaluate each method's sensitivity, specificity, turnaround time, and feasibility in clinical and surveillance settings. While culture remains the diagnostic gold standard, it is limited by slow turnaround and phenotypic overlap with related species. Updated biochemical platforms and MALDI-TOF MS with expanded databases have improved identification accuracy. Molecular assays offer rapid, culture-independent detection. Antifungal susceptibility testing (AFST), primarily using broth microdilution, is essential for guiding treatment, although standardized breakpoints remain lacking. This review proposes an integrated diagnostic workflow and discusses key innovations and gaps in current practice. Our findings aim to support clinicians, microbiologists, and public health professionals in improving early detection, containment, and management of C. auris infections.
Insights
Candida auris (C. auris) is a critical fungal threat. This review details diagnostic methods like PCR and MALDI-TOF MS for early detection and management of C. auris infections.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Candida auris (C. auris) is a multidrug-resistant fungus identified as a critical global health threat by the WHO.
- Rapid transmission, high mortality, and misidentification challenges complicate C. auris diagnosis and control.
- Effective management necessitates accurate and timely diagnostic strategies.
Purpose of the Study:
- To provide a comprehensive review of current and emerging diagnostic methods for C. auris.
- To evaluate the performance characteristics (sensitivity, specificity, turnaround time) of various diagnostic techniques.
- To propose an integrated diagnostic workflow for C. auris detection and management.
Main Methods:
- Review of culture-based techniques, biochemical assays, MALDI-TOF MS, and molecular diagnostics (PCR, LAMP).
- Evaluation of antifungal susceptibility testing (AFST) methods, primarily broth microdilution.
- Analysis of diagnostic method feasibility in clinical and surveillance settings.
Main Results:
- Culture methods are standard but slow; biochemical and MALDI-TOF MS show improved accuracy with updated databases.
- Molecular assays offer rapid, culture-independent detection of C. auris.
- Standardized breakpoints for AFST are still lacking, impacting treatment guidance.
Conclusions:
- An integrated diagnostic approach combining various methods is crucial for effective C. auris control.
- Innovations in molecular diagnostics and MALDI-TOF MS enhance early and accurate identification.
- Addressing gaps in AFST standardization and diagnostic workflows is vital for public health professionals.
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