Candida auris outbreak involving liver transplant recipients in a surgical intensive care unit

Am J Transplant. 2020 Dec;20(12):3673-3679. doi: 10.1111/ajt.16144. Epub 2020 Jul 5.


Candida auris is a yeast that is difficult to eradicate and has caused outbreaks in health care facilities. We report a cluster of 5 patients in 1 intensive care unit who were colonized or infected in 2017. The initial 2 patients were recipients of liver transplants who had cultures that grew C auris within 3 days of each other in June 2017 (days 43 and 30 posttransplant). Subsequent screening cultures identified 2 additional patients with C auris colonization. Respiratory and urine cultures from a fifth patient yielded C auris. All isolates were fluconazole resistant but susceptible to echinocandins. Whole genome sequencing showed the strains were clonal, suggesting in-hospital transmission, and related but distinct from New York/New Jersey strains, consistent with a separate introduction. However, no source or contact was found. Two of the 5 patients died. C auris infection likely contributed to 1 patient death by infecting a vascular aneurysm at the graft anastomosis. Strict infection control precautions were initiated to control the outbreak. Our experience reveals that although severe disease from C auris can occur in transplant recipients, outbreaks can be controlled using recommended infection control practices. We have had no further patients infected with C auris to date.

Keywords: clinical research/practice; infection and infectious agents; infection and infectious agents - fungal; infectious disease.

Publication types

  • Case Reports

MeSH terms

  • Antifungal Agents / therapeutic use
  • Candida
  • Candidiasis, Invasive
  • Critical Care
  • Disease Outbreaks
  • Humans
  • Intensive Care Units
  • Liver Transplantation* / adverse effects
  • Microbial Sensitivity Tests


  • Antifungal Agents

Supplementary concepts

  • Candida auris infection