Outbreak of Clonal Candida auris Candidemia in a Tertiary Care Facility

Background

Candida auris is an emerging cause of invasive fungal infection and candidemia that is associated with high antifungal resistance and a propensity for nosocomial transmission. Hospital outbreaks, particularly in intensive care units, can be difficult to control because C. auris can adhere to human skin and persist on healthcare surfaces.

Data Highlights

• The outbreak included 119 patients with C. auris candidemia from April 2023 through September 2025.

• The overall 30-day mortality rate was 53.8%.

• All 119 isolates were resistant to fluconazole.

• Two isolates had elevated echinocandin MICs and carried the FKS1 S639P substitution.

Key Findings

• Cases initially occurred in burn center-associated wards and the medical oncology service before spreading across multiple hospital wards.

• All isolates belonged to clade I, and STR genotyping identified 3 closely related genotypes consistent with clonal spread.

• The 2 isolates with elevated echinocandin MICs harbored the FKS1 S639P substitution, representing the first reported echinocandin-resistant C. auris isolates in Türkiye.

• Although ERG11 mutations are commonly associated with fluconazole resistance in clade I C. auris, the study did not report ERG11 sequencing of these outbreak isolates.

• Epidemiological and genotyping findings supported nosocomial transmission from a likely index case, highlighting the importance of rigorous infection prevention, screening, and surveillance.

Clinical Implications

The outbreak demonstrates the challenges posed by clonal spread of fluconazole-resistant C. auris in healthcare settings and the emergence of echinocandin resistance. The authors emphasize antifungal stewardship, screening, surveillance, contact precautions, environmental cleaning, and adequate isolation capacity to help limit transmission.

Conclusion

This large C. auris candidemia outbreak was associated with approximately 54% 30-day mortality, universal fluconazole resistance, and the first reported echinocandin-resistant isolates in Türkiye. Epidemiological and genotyping data supported clonal spread from a likely index patient to multiple wards, underscoring C. auris as an increasing public health threat requiring strengthened infection prevention and surveillance.

Related Resources & Content

1. Cornely OA, Sprute R, Bassetti M, et al. The Lancet Infectious Diseases. 2025 — Global Guideline for the Diagnosis and Management of Candidiasis: An Initiative of the ECMM in Cooperation With ISHAM and ASM. DOI: 10.1016/S1473-3099(24)00749-7.

2. Lionakis MS, Chowdhary A. New England Journal of Medicine. 2024 — Candida auris Infections. DOI: 10.1056/NEJMra2402635.

3. Rybak JM, Cuomo CA, Rogers PD. Current Opinion in Microbiology. 2022 — The Molecular and Genetic Basis of Antifungal Resistance in the Emerging Fungal Pathogen Candida auris. DOI: 10.1016/j.mib.2022.102208.

4. Ahmad S, Asadzadeh M. Current Fungal Infection Reports. 2023 — Strategies to Prevent Transmission of Candida auris in Healthcare Settings. DOI: 10.1007/s12281-023-00451-7.

5. Meletiadis J, Siopi M, Spruijtenburg B, et al. Eurosurveillance. 2024 — Candida auris Fungaemia Outbreak in a Tertiary Care Academic Hospital and Emergence of a Pan-Echinocandin Resistant Isolate, Greece, 2021 to 2023. DOI: 10.2807/1560-7917.ES.2024.29.45.2400128.

6. Agalar C, Erdem H, Çağ Y, et al. Turkish Journal of Medical Sciences. 2025 — Consensus Paper on Candida auris by Turkiye EKMUD, ID-IRI, THSK of Ministry of Health of the Republic of Turkiye, KLIMUD, TMC, TARD, and TYBD. DOI: 10.55730/1300-0144.6059.

7. Centers for Disease Control and Prevention. 2024 — Antifungal Susceptibility Testing for C. auris.

8. Kenters N, Kiernan M, Chowdhary A, et al. International Journal of Antimicrobial Agents. 2019 — Control of Candida auris in Healthcare Institutions: Outcome of an International Society for Antimicrobial Chemotherapy Expert Meeting. DOI: 10.1016/j.ijantimicag.2019.08.013.