Surveillance for Candida auris

Reporting

Candida auris is a nationally notifiable condition and is reportable in many states. Laboratories that identify cases of C. auris should report cases immediately to the state or local health department and to CDC at candidaauris@cdc.gov.

Surveillance for clinical cases

CDC recommends that all yeast isolates obtained from a normally sterile site (e.g., bloodstream, cerebrospinal fluid) be identified to the species level so that appropriate initial treatment can be administered based on the typical, species-specific susceptibility patterns.

C. auris has been identified from many body sites including bloodstream, urine, respiratory tract, biliary fluid, wounds, and external ear canal. Approximately half of clinical cases in the United States have been in the bloodstream and the remainder have been found in non-invasive body sites. Many clinical laboratories do not typically determine the species of isolates from non-sterile sites since presence of Candida in these sites may represent colonization rather than infection and would not require treatment. However, C. auris is important to identify even from a non-sterile body site because presence of C. auris in any body site can represent wider colonization, posing a risk for transmission and requiring implementation of infection control precautions.

When Candida is isolated from non-sterile sites, species-level identification should be considered in certain circumstances, including:

• When clinically indicated in the care of a patient.
• When a case of C. auris infection or colonization has been detected in a facility or unit, in order to detect additional patients colonized. Species identification when Candida is found in non-sterile sites can be implemented for at least one month until no evidence exists of C. auris transmission.
• When a patient has had an overnight stay in a healthcare facility outside the United States in the previous year, especially if in a country with documented C. auris transmission. Colonization for longer than a year has been identified among some C. auris patients; therefore, hospitals might also consider determining the species for Candida isolated from patients with more remote exposure to healthcare abroad.

All laboratories, especially laboratories serving healthcare facilities where cases of C. auris have been detected, should do the following:

• Review past microbiology records (as far back as 2015, if possible) to identify cases of confirmed or suspected C. auris (see When to suspect C. auris infections).
• Conduct prospective surveillance to identify and report C. auris cases in the future.

Screening for C. auris colonization

Patients may be asymptomatically colonized with C. auris on skin, nares, oropharynx, rectum, and other body sites. Patients colonized with C. auris can transmit C. auris to other patients within healthcare facilities and may be at risk for invasive C. auris infections. Screening patients for C. auris colonization allows facilities to identify those with C. auris colonization and implement infection prevention and control measures.

Screening for C. auris colonization is an important component of surveillance for C. auris. For information on who to screen and how to screen for C. auris colonization, visit Screening for Candida auris Colonization.

Drug resistance

Antimicrobial resistance is an increasing problem with C. auris.

Reports of echinocandin- or pan-resistant C. auris cases in the United States are increasing. Multiple outbreaks have been identified involving people with overlapping healthcare exposures and without previous antifungal treatment, suggesting transmission of resistant strains. Antifungal susceptibility testing should be performed for all clinical C. auris cases to guide therapy. To learn more about testing and treatment, visit Antifungal Susceptibility Testing or Treatment and Management of Infections and Colonization.