Hospital-acquired fungal infections by Candida auris and Aspergillus species: Pathogenesis, resistance mechanisms, prevention and control measures

Background: As multidrug-resistant fungal pathogens including Aspergillus species and Candida auris are becoming more common, hospital-acquired infections (HAI) or nosocomial infections have grown to be a serious public health concern. HAI is the most common adverse event in healthcare that jeopardizes patient safety. They significantly affect morbidity, mortality, and cost burden on people, families, and healthcare systems. Another issue associated with HAI is the development of bacteria that are resistant to numerous medications. HAI has affected 3.2% of all hospitalized patients in the US and 6.5% in the EU/EEA, indicating a likely much larger frequency worldwide. The worldwide burden of HAIs is unknown because there are few HAI surveillance systems in place. Since its discovery in 2009, C. auris has quickly gained global attention and trigger outbreaks in hospital environment with high rates of morbidity and mortality. Candida has an exceptional capacity to survive on medical surfaces, elude traditional antifungal medications. Simultaneously, Aspergillus species also associated with hospital outbreaks mostly cause infection in immunocompromised patients, predominantly in intensive care units and other high-risk hospital environments. These pathogens also being prominent contributors in the blood stream infections (BSIs). Blood stream infections occur due to the direct and indirect introduction of pathogens into vascular systems even facilitated hospital procedure and medical devices. This review aimed to describe the pathophysiology, epidemiology and drug-resistant mechanism of Aspergillus spp. and C. auris along with diagnosing and treatment of such diseases. Current and emerging diagnostic tools, antifungal therapies and different strategies to control infections are also covered.