Candida auris

Cause: Candida auris (C. auris) is a type of fungus (also called a yeast) that can cause severe illness and spreads easily among patients in healthcare facilities.

Illness and treatment: C. auris can cause a range of infections from superficial (skin) infections to more severe, life-threatening infections, such as bloodstream infections. C. auris mostly affects hospitalized patients requiring complex medical care including patients with invasive medical devices like breathing or feeding tubes, or catheters. About 30-60% percent of patients with an invasive C. auris infection die, however, most fatal cases have other serious comorbidities which may cause or contribute to death. C. auris may also colonize the skin and other body sites. Both infected and colonized patients can transmit the organism to other patients via healthcare workers' hands or contaminated equipment and surfaces. Consultation with an infectious disease specialist for treatment guidance is highly recommended. The Centers for Disease Control and Prevention (CDC) does not recommend treatment of C. auris identified from non-sterile sites (such as respiratory tract, urine, and skin) when there is no evidence of infection and no recommended treatment to eliminate colonization with C. auris.

Sources: Healthcare personnel's hands and other contaminated items in healthcare settings are the most frequent sources for the spread of C. auris.

Prevention: The best way to prevent colonization and infections with C. auris is meticulous adherence to infection control precautions in healthcare settings including:

Clean hands frequently with alcohol-based hand sanitizer (ABHS).
- Soap and water if hands are soiled or ABHS is not available.
Place patients with C. auris separate from other patients.
Clean the patients' room and equipment often using an effective disinfectant.
Wear gloves and gown to deliver care.
Ensure visitors clean hands with ABHS (preferred) or soap and water before and after visits.

Recent Washington trends: C. auris was first reported in Washington in 2023 and, since January 2024, has been detected in patients in several healthcare facilities and counties. C. auris may continue to spread among patients in several healthcare facilities, as it has in other states.

Information for Laboratories: Candida auris can be mistaken for other Candida species, such as Candida haemulonii, Candida duobushaemulonii, Rhodotorula glutinis, Candida intermedia, Candida sake, Saccharomyces kluyveri, Candida catenulate, Candida famata, Candida guilliermondii, Candida lusitaniae, and Candida parapsilosis, by certain yeast identification assays, such as VITEK 2 YST, API 20C, BD Phoenix yeast identification system, and MicroScan. Laboratories should know the limitations of their yeast identification system by reviewing Identification of Candida auris to avoid mistakenly identifying C. auris as another fungal species. Commercial labs may serve as Candida sentinel labs and submit to PHL all Candida species except albicans. For information about sentinel labs, please contact the Washington Antibiotic Resistance Lab Network at ARLN@doh.wa.gov

Purpose of Reporting and Surveillance

To increase awareness of Candida auris by public health and healthcare professionals.
To promote appropriate infection control interventions to prevent transmission of Candida auris between patients in healthcare facilities and between healthcare facilities.
To rapidly identify Candida auris and prevent or eliminate sources or sites of ongoing transmission within Washington.
To better characterize the epidemiology of Candida auris infections in Washington to guide response.

Legal Reporting Requirements

1.Health care providers and Health care facilities: notifiable to the local health jurisdiction within 24 hours.

2.Laboratories: lab report to the local health jurisdiction (LHJ) within 24 hours; submission required to PHL– isolate or if no isolate specimen associated with positive result, within 2 business days.

Positive result by any method including, but not limited to, culture, nucleic acid detection (NAT or NAAT), or whole genome sequencing;
Isolates should be accompanied by a Public Health Laboratories (PHL) Antibiotic Resistance Lab Network (ARLN) Requisition Form. See ARLN Test Menu and Specimen Collection and Submission Instructions for details on isolate submission.

3. Local health jurisdictions: notifiable to Washington State Department of Health (DOH) Office of Communicable Disease Epidemiology (CDE) within 7 days of case investigation completion or summary of information required within 21 days.