Candida auris in the neonatal intensive care unit

Candida (a.k.a.Candidozyma) auris is a healthcare-associated yeast that has attracted attention due to its increased antimicrobial resistance and ability to spread rapidly within the healthcare environment. Infants admitted to the neonatal intensive care unit (NICU) have risk factors such as broad spectrum antibiotic exposure, prematurity and congenital heart disease that predispose them to serious infection with C. auris. Consequently, there have been global reports of C. auris outbreaks in NICUs associated with high mortality. The clinical presentation of late onset sepsis with C. auris is indistinguishable from other etiologies. Echinocandins remain the empiric therapy of choice along with amphotericin B in select cases. Identification of an invasive case of C. auris in the NICU requires implementation of infection prevention and control measures including contact precautions, enhanced environmental cleaning and disinfection, and the screening of other infants for colonization. Areas where research is needed include optimal antifungal therapy for treatment and prophylaxis, the ideal body sites to screen for colonization, the length of time infants remain colonized with C. auris, and the risk of infant colonization from breast feeding and skin-to-skin practices with colonized or infected caregivers. Continued reporting of the clinical experience of NICUs that experience C. auris is essential to expand our knowledge and to protect neonates and infants from this evolving pathogen.