Candidozyma auris (formerly Candida auris): resistant, long lasting, and everywhere

Abstract

Background: Invasive fungal diseases represent a significant global health concern, with Candidozyma auris (formerly Candida auris) emerging as a major healthcare-associated pathogen. Its multidrug resistance, environmental persistence, prolonged skin colonization, and efficient nosocomial transmission have driven sustained outbreaks and endemicity worldwide, and recent taxonomic changes have further complicated surveillance and diagnostics.

Objectives: This narrative review summarizes current evidence on the taxonomy, epidemiology, clinical impact, antifungal resistance, transmission, and infection prevention and control (IPC) of C. auris, highlighting outbreak drivers, regional endemicity, and key gaps relevant to surveillance and policy.

Sources: We conducted a structured narrative review of peer-reviewed and grey literature published between 2009 and 2025, drawing from PubMed/MEDLINE, Embase, Scopus, Web of Science, and major public health websites, such as the WHO, the CDC, the European Centre for Disease Prevention and Control, the UK Health Security Agency, and national surveillance portals.

Content: C. auris has rapidly evolved into an endemic healthcare threat across multiple continents, with substantial regional variation in incidence, outbreak dynamics, antifungal resistance, and control capacity. Candidemia mortality averages ∼30% but differs by region and patient population. Azole resistance is widespread in several clades, whereas resistance to amphotericin B and echinocandins is increasingly reported, particularly in high-endemic settings. Outbreaks are sustained by environmental persistence, prolonged skin colonization, and healthcare-associated transmission, amplified by intensive care exposure, antimicrobial pressure, and system strain during the COVID-19 pandemic. Despite broadly aligned IPC guidance, major challenges persist in screening, decolonization, laboratory identification, and long-term outbreak control.

Implications: The continued global expansion of C. auris has major clinical, economic, and public health implications. Effective control requires sustained investment in laboratory capacity, standardized nomenclature adoption, active surveillance, genomic monitoring, and rigorous IPC measures tailored to the pathogen's unique biology. Without coordinated regional and international responses, C. auris is likely to continue shifting from epidemic emergence to entrenched endemicity in diverse healthcare systems worldwide.

Keywords: Antifungal resistance; Candidozyma auris; Epidemiology; Healthcare-associated infections; Infection prevention and control; Invasive fungal disease.