CDC: Increasing Cases of Multi-Drug Resistant Fungus Present Public Health Threat Interview with:
Dr. Meghan Lyman MD
Medical Officer in the Mycotic Diseases Branch
CDC What is the background for this study?

Response: Candida auris (C. auris) is a fungus considered an urgent public health threat because it is often multi-drug resistant and spreads easily in healthcare settings.  CDC has been conducting tracking cases and is concerned about increasing numbers and geographic spread of C. auris cases in recent years, suggesting increased transmission.  Because C. auris cases and resistance are rising in the U.S., immediate public health actions to stop this threat are critical.

Candida auris - cdc image - shawn lockhart

Candida auris – CDC Image Would you briefly explain the conditions caused by Candida auris?

Response: Symptoms depend on the part of the body affected and may be similar to infections from other bacteria or viruses. C. auris can cause many different types of infection, such as bloodstream infections, urinary tract infections, wound infections, and ear infections. Some people can have C. auris on their skin or other body sites without causing infection (called colonization).  Because symptoms can vary greatly, a laboratory test is needed to determine whether a patient is colonized or infected with C. auris. What are the main findings?

Response:  Cases of C. auris have continued to increase, with a greater increase in recent years. Cases increased not only within areas with established transmission, but also in areas with minimal previous transmission or no prior cases. Equally concerning was a tripling in 2021 of the number of cases that were resistant to echinocandins, the antifungal medicine most often recommended for treatment of C. auris infections.

Clinical cases (in which infection is present) have increased each year since 2016, with the most rapid rise occurring during 2020-2021. CDC has continued to see an increase in case counts for 2022. During 2019-2021, 17 states identified their first C. auris case ever. Nationwide, clinical cases rose from 476 in 2019 to 1,471 in 2021. Screening cases (in which the fungus is detected but not causing infection) tripled from 2020 to 2021, for a total of 4,041. What should readers take away from your report?

Response: The rapid rise in cases and geographic spread emphasize the need for continued surveillance, expanded laboratory capacity, quicker diagnostic tests, and robust infection prevention and control. We have an opportunity to turn the tide and keep this bug from taking hold in the U.S.—but it will take comprehensive efforts by local health departments and health care facilities to stop its spread.

They should also remember that people who are very sick at baseline, including those on ventilators, with lines and tubes that go into their body (such as breathing tubes, feeding tubes and central venous catheters), recent exposures to antimicrobial medications, and long or frequent stays in healthcare settings seem to be at highest risk for C. auris infection. Generally speaking, the average, healthy person is low risk for C. auris infection. What recommendations do you have for future research as a results of this study?

Response: Outcome data for C. auris is limited but would help understand the impact of C. auris colonization or infection on patients and identify the most effective treatments.  More research on patient colonization would also help us understand and develop prevention strategies. Is there anything else you would like to add?

Response: Despite the increase in cases and transmission, there have been multiple facilities and geographic areas that have successfully prevented or contained C. auris.


Meghan Lyman, Kaitlin Forsberg, D. Joseph Sexton, et al. Worsening Spread of Candida auris in the United States, 2019 to 2021. Ann Intern Med. [Epub 21 March 2023]. doi:10.7326/M22-3469

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