5 things to know about an emerging drug-resistant fungus now putting hospitals at risk of outbreaks

Memo to health execs: If your hospital hasn’t had a C. auris scare yet, odds are quite high that it soon will. 

That’s because the name refers to a yeast-based fungus that spreads easily, persists on surfaces, strongly resists drug interventions—and has been proliferating in hospitals ever since it was reported in the U.S. 10 years ago.

It also can lead to severe and frequently fatal bloodstream infections. 

The Candida auris threat is in the news after the CDC issued a surveillance notice June 30 (forward-dated to July 2 in the agency’s Morbidity and Mortality Weekly Report). 

Clinical cases of C. auris infection skyrocketed 96% from 2021 to 2022, nearly reaching 3,000 cases, the notice shows. It has been spreading more slowly since then but, by CDC’s calculations, still has potential to force a national reckoning. 

As it happens, one state issued a health alert after clocking 129 cases just a week and a half ago. 

Here are five key takeaways from this week’s surveillance update on C. auris from CDC epidemiologist Jeremy Gold, MD, and colleagues at the agency. 

1. The continued increase in clinical C. auris case counts reported to CDC during the study period—2022 to 2024—underscores the establishment and ongoing transmission of this pathogen. 

Clinical cases most frequently involved specimens collected from patients in acute-care hospitals (76.6%) and long-term acute-care hospitals (17.8%), although the data do not indicate where transmission might have occurred, CDC reports. 

“This finding highlights the importance of strict adherence to infection prevention and control measures in healthcare facilities,” Gold and co-authors remark. “CDC recommendations involve several core components of infection prevention and control in healthcare settings, including rigorous hand hygiene practices, the use of disinfectants effective against C. auris in facilities caring for patients with C. auris, and the implementation of transmission-based precautions.”  

2. The number of screening C. auris cases reported to CDC increased from 6,226 in 2022 to 12,432 in 2024.

By 2024, screening cases were most frequently detected in acute-care hospitals, Gold and team note. 

“Acute-care hospitals might be identifying colonized patients at the time of admission through expanded in-house or admission screening protocols or policies, even when colonization acquisition occurred at another facility,” the C. auris surveillance team advises. 

3. The smaller-percentage increases observed after 2022 might reflect the success of several mitigation measures. 

Not least among these would be a renewed focus on standard protocols and other healthcare-associated infections, CDC suggests, pointing in particular to “the resolution of personal protective equipment shortages and staffing challenges experienced during the earlier phases of the COVID-19 pandemic.”

“Improved testing capacity might also have contributed to greater detection of clinical C. auris cases over time as laboratories have increasingly adopted species-level identification or updated laboratory equipment to properly identify C. auris,” the CDC researchers write. “Increased screening, particularly in acute-care hospitals and changes in testing and reporting practices over time might also have contributed.” 

4. Approximately one third of reported clinical cases (30.2%) were identified from blood specimens. 

Because isolating Candida from blood indicates an invasive infection, this result is concerning due to the pathogen’s frequent antifungal drug resistance and high mortality (30% to 72%), the researchers write. 

“Trends in nonblood specimen types should be interpreted with caution because changes in laboratory practices, such as expanded species-level identification of yeast from nonsterile sources (e.g., urine), might influence their relative distribution over time,” they add. “These findings underscore the importance of efforts to prevent healthcare-associated Candida bloodstream infections.” 

5. C. auris remains a critical public health concern in the United States.

It continues to be most frequently identified among middle-aged and older adults, particularly in specimens collected from patients in acute-care hospitals and long-term acute-care hospitals, CDC reports. 

From 2022 to 2024, the number of clinical C. auris cases reported to CDC increased approximately twofold—from 2,882 to 6,197. 

“Although the annual percent increase in reported cases decreased during the study period, the continued rise in cases underscores ongoing transmission in healthcare settings,” Gold and CDC co-researchers warn.

They add that the data further suggests the “importance of infection prevention and control efforts, with continued support from federal, state and local public health partners to prevent further spread.”

To read or share the full notice, click here.