1. This description of national surveillance data demonstrated that Candida auris (C. auris) cases and transmission have increased in the United States from 2019 to 2021.

2. The data also showed a rise in echinocandin-resistant cases and transmission.

Evidence Rating Level: 1 (Excellent)

Study Rundown: C. auris has been identified as increasing in cases and transmission over the past decade, with the Centers for Disease Control and Prevention (CDC) referring to it as an urgent threat. Notably, C. auris is often multidrug-resistant, spreads easily in healthcare facilities, and can cause severe invasive infections with high mortality rates. However, there is a gap in knowledge as to understanding the changes in the United States epidemiology of C. auris between the years 2019 and 2021 to characterize recent trends. Overall, this description of national surveillance data found that C. auris cases and transmission have significantly increased, with a dramatic rise in 2021. Notably, there was also a trend of an increasing number of echinocandin-resistant C. auris cases. This study was limited by identifying screening cases on the basis of need and available resources, as well as screening not being conducted uniformly across the United States, which can underestimate the true burden of C. auris cases. Nevertheless, these study’s findings are significant, as they demonstrate that C. auris is becoming a serious public health concern in the United States due to its rapid rise in transmission and cases.

Click to read the study in AIM

Relevant Reading: Candida auris: An Emerging Antimicrobial Resistance Threat

In-Depth [description of national surveillance data]: This study examined C. auris cases (confirmed and probable cases, but not suspected cases) reported to state and local health departments and CDC during the period from the first United States case—which occurred in 2013 but was reported retrospectively in 2016—through 31 December 2021. Patients with clinical cases with C. auris–positive specimens (for example, blood or urine) collected as part of routine clinical care or screening cases with C. auris–positive skin swabs collected during colonization screening were eligible for the study. Patients who did not meet these criteria were excluded from the study. The primary outcome measured was C. auris positive cases. Outcomes in the primary analysis were assessed via antifungal susceptibility testing. Isolates that were resistant to echinocandins were considered to be resistant to that class. Isolates that were resistant to all three antifungal classes were considered to be pan-resistant. Based on the primary analysis, 3,270 clinical cases and 7,413 screening cases of C. auris were reported in the United States through 31 December 2021. The percentage increase in clinical cases grew each year, from a 44% increase in 2019 to a 95% increase in 2021. Colonization screening volume and screening cases increased in 2021 by more than 80% and more than 200%, respectively. From 2019 to 2021, 17 states identified their first C. auris case. The number of C. auris cases that were resistant to echinocandins in 2021 was about three times that in each of the previous two years, demonstrating that echinocandin resistance continued to increase as time passed. In summary, this study shows that C. auris cases and transmission have continued to rise in the United States.

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