European health officials are warning that the multidrug-resistant and deadly yeast Candida auris (Candidozyma auris) is spreading rapidly in European hospitals.
The European Centre for Disease Prevention and Control (ECDC) said today that its latest survey shows C auris case numbers have been rising in several European countries in recent years, with Spain, Greece, Italy, Romania, and Germany accounting for the most cases. Of the 4,012 cases reported in European Union/European Economic Area (EU/EEA) countries from 2013 through 2023, more than half were in 2022 and 2023.
The ECDC said health officials in Spain, Italy, Greece, and Romania have indicated they can no longer distinguish specific outbreaks due to widespread dissemination of C auris, which spreads easily in hospitals.
“C. auris has spread within only a few years – from isolated cases to becoming widespread in some countries,” Diamantis Plachouras, MD, PhD, head of ECDC’s Antimicrobial Resistance and Healthcare-Associated Infections section, said in an ECDC press release. “This shows how rapidly it can establish itself in hospitals.”
And ECDC officials says those cases are likely just the tip of the iceberg, because systematic surveillance isn’t in place in many countries.
Rapid dissemination of C auris a ‘serious concern’
First identified in Japan in 2009, C auris has spread rapidly around the world, causing severe invasive infections in critically ill and immune-compromised patients and causing outbreaks in hospitals. The World Health Organization has labeled it a fungal priority pathogen.
The danger posed by the pathogenic yeast stems in part from its resistance to antifungal treatments. Primarily resistant to fluconazole, C auris has also shown varying levels of resistance to the two other primary antifungal classes—echinocandins and amphotericin B. Mortality rates range from 29% to 62%.
C auris also likes to colonize patients’ skin and transmits easily in healthcare settings, spreading from patients to bed rails, hospital curtains, floors, and healthcare workers. It’s also shown the ability to persist on hospital surfaces for months. Hospitals have had trouble eradicating it with standard disinfectants.
C. auris has spread within only a few years – from isolated cases to becoming widespread in some countries.
The 2024 ECDC survey—the fourth conducted by the agency—shows that C auris cases began to pick up noticeably in Europe in 2000 and have been steadily climbing since then, with 1,346 cases reported by 18 countries in 2023 alone. Three countries (Cyprus, France, and Germany) reported distinct outbreaks in 2023.
Spain, the first EU/EEA country to report a C auris hospital outbreak, in 2016, reported the most cases from 2013 through 2023, with 1,807. Greece and Italy reported 852 and 712 cases, respectively. The ECDC said the 5 to 7 years between the first documented cases in those countries and regional endemicity shows how rapidly the fungus spreads through hospital networks.
“This rapid dissemination of C. auris is of serious concern and points to a high risk for continued C. auris spread throughout European healthcare systems,” the ECDC said. “With increasing C. auris cases and its widespread geographic distribution, sustained control will become more difficult.”
The survey also highlights key gaps in national preparedness. Only 17 of 36 countries currently have a national surveillance system in place, and only 15 have specific national infection prevention and control (IPC) guidance. But the ECDC said national efforts for surveillance and early detection and implementation of IPC measures could delay further spread of C auris and mitigate its impact on hospital patients.
The number of clinical C auris cases has also been on the rise in the United States, with 4,514 new cases reported in 2023, according to tracking data from the US Centers for Disease Control and Prevention (CDC). Next week, CDC officials will hold a Clinician Outreach and Communication Activity call to review evidence of rising antifungal resistance in C auris and discuss recommendations for testing and treatment.
Editor’s note: This story was updated at 1:45pm
