Guidance for the laboratory investigation, management and infection prevention and control for cases of Candida auris
SHPN guide to using the external guidance

Investigation in clinical laboratories

Page 4 to 6 cover the investigation in clinical laboratories.

The following supplementary information relates to the need for identification to species level for:

• any Candida spp. isolates from blood cultures
• as a minimum, other isolates judged as clinically significant from deep sample sites from all patients
• any isolates from patients transferred from an affected hospital (UK or abroad)

At the moment Bruker MALDI-TOF (Biotyper) is the most reliable speciation system for C. auris.

For laboratories which do not have this system we suggest that any isolate that identifies as C. famata, C. haemulonii, C. sake, C. lusitaniae, Saccharomyces cerevisiae, or unidentified isolates, is screened for ability to grow at 42°C and/or high level fluconazole resistance by disc, antimicrobial gradient diffusion method (e.g. Etest) or VITEK 2, or is sent to a laboratory with a Bruker MALTI-TOF Biotyper for confirmation.

Suspicious/possible C. auris isolates should be sent to the PHE Mycology Reference laboratory in Bristol.

The fluconazole disc method reference is: CLSI M44 A2 (Clinical and Laboratory Standards Institute. 2009. Method for Antifungal Disk Diffusion Susceptibility Testing of Yeasts, 2nd ed. Approved Guideline. Document M44-A2. Clinical and Laboratory Standards Institute, Wayne, PA.) For Vitek 2 and Gradient diffusion as per manufacturers guidance.