Clinical Scorecard: Outbreak of Clonal Candida auris Candidemia in a Tertiary Care Facility with the First Reported Echinocandin-Resistant Strains in Türkiye

At a Glance

Key Highlights

• The outbreak involved 119 patients with C. auris candidemia and an overall 30-day mortality rate of 53.8%.

• All 119 isolates were resistant to fluconazole, and 2 isolates had elevated echinocandin MICs with the FKS1 S639P substitution.

• C. auris outbreaks are difficult to control because the organism can adhere strongly to human skin, spread directly, and persist on abiotic surfaces in healthcare environments.

• Genotyping assigned all isolates to clade I and identified 3 closely related genotypes, supporting clonal spread across multiple wards.

• The true burden of C. auris in Türkiye is likely underestimated because financial and structural limitations may hinder accurate and timely diagnosis.

Guideline-Based Recommendations

The study was an outbreak investigation rather than a clinical guideline; the following reflects diagnostic, treatment, surveillance, and infection-prevention practices described or supported by the authors and cited guidance.

Diagnosis

• Blood cultures were used to identify candidemia, and isolates were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry.

• The authors state that screening patients at hospital or ICU admission by culture or molecular methods is important to help prevent transmission from colonized individuals to other at-risk patients.

Management

• Echinocandins are described as the drugs of choice for candidemia, although fluconazole is often used in low- to middle-income countries because of its lower cost and greater accessibility.

• The authors emphasize optimal antifungal stewardship because all isolates were fluconazole resistant and fluconazole was used in a proportion of patients.

Monitoring & Follow-up

• In the study, antifungal susceptibility testing was performed against 8 antifungal agents, and isolates with elevated echinocandin MICs underwent FKS1 hotspot sequencing.

• Short tandem repeat genotyping was used to assess genetic relatedness among isolates and investigate outbreak transmission.

• The authors highlight continuous surveillance and longitudinal monitoring as important for detecting and reversing established endemic transmission.

Risks

• C. auris poses a substantial risk of nosocomial spread, particularly in intensive care settings.

• Resistance to fluconazole was universal in this outbreak, and the study reported the first echinocandin-resistant C. auris isolates in Türkiye.

Patient & Prescribing Data

The study included 119 patients with C. auris candidemia. Most cases occurred in ICU wards, accounting for 106 of 119 cases (89.1%); 92.4% of patients had a central venous line, 79.8% required mechanical ventilation, and 78.2% received steroids.

Echinocandin monotherapy was the most common antifungal regimen, used in 52.1% of patients, followed by fluconazole plus an echinocandin in 21.0%. A total of 25.2% received no antifungal treatment.

Clinical Best Practices

• Implement rigorous infection-prevention practices, screening, and surveillance for C. auris in healthcare settings.

• Institute contact precautions and appropriate environmental cleaning promptly after the first positive case is detected to help limit outbreak spread.

• Maintain adequate structural capacity for isolation of infected and colonized patients and use monitoring systems to anticipate epidemiological changes.

Related Resources & Content

• Global Guideline for the Diagnosis and Management of Candidiasis: An Initiative of the ECMM in Cooperation With ISHAM and ASM — Cornely OA, Sprute R, Bassetti M, et al; The Lancet Infectious Diseases; 2025; 25:e280-e293; DOI: 10.1016/S1473-3099(24)00749-7.

• Candida auris Infections — Lionakis MS, Chowdhary A; New England Journal of Medicine; 2024; 391:1924-1935; DOI: 10.1056/NEJMra2402635.

• Strategies to Prevent Transmission of Candida auris in Healthcare Settings — Ahmad S, Asadzadeh M; Current Fungal Infection Reports; 2023; 17:36-48; DOI: 10.1007/s12281-023-00451-7.

• Candida auris Fungaemia Outbreak in a Tertiary Care Academic Hospital and Emergence of a Pan-Echinocandin Resistant Isolate, Greece, 2021 to 2023 — Meletiadis J, Siopi M, Spruijtenburg B, et al; Eurosurveillance; 2024; 29:2400128; DOI: 10.2807/1560-7917.ES.2024.29.45.2400128.

• 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 — Agalar C, Erdem H, Çağ Y, et al; Turkish Journal of Medical Sciences; 2025; 55:1039-1062; DOI: 10.55730/1300-0144.6059.

• Antifungal Susceptibility Testing for C. auris — Centers for Disease Control and Prevention; 2024; available from the CDC Candida auris laboratory guidance page.