The Importance of Candida auris in Skin

Candida auris has been recognized recently as an agent of outbreaks of severe disease, usually in healthcare environments. As a multi-drug resistant pathogen, cases are associated to high mortality rates. The human skin is considered to be the main reservoir of this yeast in the context of disease. This work aims to review the C. auris colonization prevalence, patterns, and mechanisms, as well as give a brief account of the methods for screening and control being used.

There are high rates of skin colonization involving individuals residing in multi-occupancy healthcare facilities. Although the axilla, groin, and nares are considered the main niches for colonization, there is evidence of C. auris presence in other anatomical sites. Ex vivo and in vivo models have shown a higher burden of C. auris in folds and crevices of the skin, as well as a capacity to burrow within skin follicles. Colonization of C. auris relates to other changes in microbiota, namely increased Candida spp. and Gram-negative bacteria relative abundance.

As current therapies are largely ineffective against C. auris, prevention is today the only control measure to curtail disease and outbreaks. Strategies for proper screening should be established to better detect potential cases in vulnerable groups, and protocols for effective decolonization prophylaxis and reestablishing of healthy skin microbiota should be a priority. Further studies on C. auris skin colonization are needed, especially those related to its patterns and mechanisms, to better understand the factors that favor this altered state.