This Scottish Health Protection Network (SHPN) guide should be used alongside the external guidance that it relates to.
This guide covers the UKHSA 'Guidance for the laboratory investigation, management and infection prevention and control for cases of Candida auris'.
This external guidance has been approved for use in Scotland by the SHPN Guidance Group (SHPN-GG).
This guidance is for health protection professionals only.
Other people who require advice should contact their local health protection team.
What the guidance covers
This guidance covers:
- sending Candida spp isolates for laboratory testing
- treatment and decolonisation of patients and screening in hospitals
- infection prevention and control measures
Guide for use in Scotland
The following recommendations for using this guidance in Scotland were agreed by the SHPN through the agreed review and adoption process.
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.
Infection, prevention and control (IPC)
Pages 10 to 13 set out infection, prevention and control advice. Users of the guidance in Scotland should refer to the National Infection Prevention and Control Manual.’
View the external guidance
This external guidance should be used together with the guide for use in Scotland provided on these pages.