CANDIDA AURIS is shifting from outbreaks to endemicity propelled by resistance, persistence, and efficient healthcare transmission.
Candida auris Is Becoming an Endemic Healthcare Threat
A narrative review describes how Candidozyma auris, formerly known as Candida auris, has expanded into a major healthcare associated pathogen across multiple continents. The authors report substantial regional variation in incidence, outbreak dynamics, antifungal resistance patterns, and local capacity to contain spread. They also highlight the clinical burden of invasive infection, noting that candidemia mortality averages about 30% overall, while outcomes differ by region and by patient population.
What Drives Candida auris Persistence and Transmission
The review argues that sustained outbreaks reflect pathogen biology as much as healthcare exposure. Candida auris is notable for environmental persistence, prolonged skin colonization, and efficient nosocomial transmission. These traits can enable continued spread despite routine cleaning and standard workflows. The authors identify intensive care exposure, antimicrobial pressure, and health system strain during the COVID-19 pandemic as amplifiers that increase opportunities for transmission and complicate long term outbreak control.
Antifungal Resistance Narrows Clinical Options
Antifungal resistance remains a central concern for bedside decision making. The review notes that azole resistance is widespread in several clades. It also describes increasing reports of resistance to amphotericin B and to echinocandins, particularly in settings where Candida auris is already highly endemic. This trend can narrow therapeutic options and increases the importance of timely species level identification and susceptibility informed management when Candida auris is suspected. The authors also emphasize persistent challenges in screening, decolonization, and laboratory identification that can delay containment.
Surveillance and Infection Prevention Priorities
The authors conclude that durable control requires sustained investment in laboratory capacity, consistent adoption of standardized nomenclature, active surveillance, and genomic monitoring to track spread and resistance evolution. They stress rigorous infection prevention and control measures tailored to Candida auris, given its persistence on surfaces and prolonged skin colonization. In practice, screening approaches are evolving, including in-house PCR testing and attention to sampling sites such as anterior nares and hands swabs. Without coordinated regional and international responses, the review suggests Candida auris is likely to continue transitioning from epidemic emergence to entrenched endemicity.
Reference: Salmanton-García J et al. Candidozyma auris (formerly Candida auris): Resistant, long-lasting, and everywhere. Clin Microbiol Infect. 2026;doi: 10.1016/j.cmi.2025.12.022.
