Drug-Resistant Fungus Candida auris Spreads Rapidly in European Hospitals

According to THE TELEGRAPH

Surge in Drug-Resistant Fungal Infections Across European Hospitals

Brussels, September 2025 — A multidrug-resistant fungus, Candida auris, is spreading rapidly across hospitals in Europe, according to the latest risk assessment published by the European Centre for Disease Prevention and Control (ECDC).

In 2023, 1,346 cases of Candida auris were reported across 18 countries in the EU/EEA region, a significant increase from the 335 cases recorded in 2022. The total number of reported cases since 2013 now exceeds 4,000. The ECDC warns that without enhanced surveillance and coordinated infection prevention strategies, further outbreaks are likely.

Pathogen Overview

Candida auris is an emerging fungal pathogen first identified in Japan (2009). It has since been detected in 40+ countries.

The organism poses a threat to hospitalized patients due to its:

• Resistance to multiple antifungal drugs
• Ability to colonize skin and persist in healthcare environments
• Potential to cause invasive infections

It is classified by the CDC as an “urgent threat.”

Transmission and Characteristics

C. auris can be transmitted through:

• Contact with contaminated surfaces
• Medical equipment
• Colonized patients

Unlike other fungal pathogens, C. auris survives for extended periods on plastic and metal surfaces, including bed rails, catheters, and door handles.

It is also resistant to many standard hospital disinfectants.

Mortality rates for invasive C. auris infections are estimated between 30–60%.

Geographic Distribution

According to the ECDC’s assessment:

• Spain, Greece, Italy, Romania, and Germany reported the highest number of cases.
• In Greece, Italy, Romania, and Spain, the fungus is considered endemic.
• Outbreaks have occurred in France, Germany, and Cyprus.

Surveillance and Reporting Gaps

Out of 36 surveyed countries in Europe:

• Only 17 countries reported having a national surveillance system.
• Only 15 countries had national guidelines for infection prevention.
• Several countries had limited lab capacity → possible underreporting.

The ECDC emphasizes that inadequate reporting and diagnostic delays hinder outbreak response.

Drug Resistance Profile

C. auris is resistant to multiple classes of antifungal medications:

• 90%+ of strains → resistant to fluconazole
• Growing resistance to amphotericin B & echinocandins
• Pan-resistant strains documented in multiple countries

Infection Prevention and Control Measures

The ECDC recommends:

• Screening & isolation of exposed patients
• Environmental decontamination with fungal-effective disinfectants
• Strict hand hygiene
• Cohorting of staff/equipment
• Enhanced diagnostics: MALDI-TOF / PCR

Clinical Impact and Healthcare Burden

Hospitals with outbreaks report:

• Increased ICU stays
• Extra isolation protocols
• Disruption of elective surgeries
• Higher costs of antifungals + disinfection
• Heavy strain on microbiology & infection control teams

Policy Recommendations

The ECDC and health agencies call for:

• Mandatory case reporting across EU states
• National AMR plans to include fungi
• Research funding for new antifungals
• Specialist training programs
• Cross-border coordination

The European Commission is reviewing proposals to integrate fungal surveillance into its AMR strategy (2026–2030).

Global Context

Beyond Europe, C. auris is reported in:

• United States (CDC, 2022) — 2,377 cases
• India & Pakistan — high prevalence
• South America — outbreaks in Venezuela, Colombia, Brazil
• South Africa — early endemic spread

The WHO lists C. auris as a high-priority fungal pathogen.

Conclusion

The rapid increase of Candida auris in European hospitals reveals critical gaps in infection control, diagnostics, and antifungal resistance preparedness.

Without coordinated action, the fungus could become endemic in more healthcare systems, posing severe risks to patient safety and public health resilience.

References

• CDC – Candida auris

According to THE TELEGRAPH

Frequently Asked Questions

Why is Candida auris considered more dangerous than other Candida species?

Candida auris differs from other Candida species in several key ways that make it especially dangerous in healthcare settings. First, it is intrinsically resistant to fluconazole (the first-line azole antifungal)—a resistance that is built into the species rather than acquired. Second, it can rapidly develop resistance to additional antifungal classes during treatment. Third, it survives on hospital surfaces (bedrails, infusion pumps, door handles) for weeks—far longer than typical Candida species. Fourth, standard laboratory methods often misidentify it as other Candida species, delaying appropriate treatment. Fifth, it forms biofilms on medical devices that resist both antifungals and disinfectants.

How does C. auris spread in hospitals and who is at risk?

Candida auris spreads primarily through direct patient-to-patient transmission via contaminated hands of healthcare workers, and through contact with contaminated environmental surfaces and medical equipment. Skin colonisation without active infection can persist for months. High-risk patients include those in intensive care units, with central venous catheters or urinary catheters, receiving broad-spectrum antibiotics or antifungal prophylaxis, with recent surgery, on mechanical ventilation, receiving immunosuppressive therapy (organ transplant, cancer chemotherapy), or with diabetes. Neonatal ICUs have experienced significant C. auris outbreaks.

How are European hospitals responding to C. auris outbreaks?

European responses to C. auris have been coordinated through the European Centre for Disease Prevention and Control (ECDC), which issued a Rapid Risk Assessment and now collects surveillance data from member states. Hospital-level responses include enhanced contact precautions (dedicated room, gowning and gloving by all staff); systematic screening of exposed patients; environmental sampling and enhanced terminal cleaning using sporicidal agents (quaternary ammonium compounds are insufficient—chlorine-based products at ≥1000 ppm are required); enhanced hand hygiene audits; and antifungal stewardship programmes to reduce selection pressure. Some hospitals have achieved elimination through aggressive outbreak response; others have experienced prolonged endemic transmission.

What treatments are available for C. auris infections?

The echinocandin class (caspofungin, micafungin, anidulafungin) remains the first-line treatment for most C. auris infections, as resistance to this class is less common than azole or polyene resistance. However, echinocandin-resistant strains are increasing. For pan-resistant strains (resistant to all three classes), treatment options are extremely limited and experimental: the recently approved antifungal ibrexafungerp (a triterpenoid with a different mechanism from echinocandins) shows activity; olorofim (a dihydroorotate dehydrogenase inhibitor) is in clinical trials; and combination antifungal therapy is sometimes attempted. Treatment must be guided by susceptibility testing of each clinical isolate.

What is the connection between climate change and the emergence of C. auris?

A 2019 paper in mBio by Casadevall et al. proposed a provocative hypothesis: that C. auris’s simultaneous emergence on four continents (South Asia, South Africa, South America, and East Asia) around the same time (2009–2012) suggests adaptation to higher temperatures rather than geographic spread. Fungi are generally restricted by mammalian body temperature (37°C)—our thermal immunity. If rising ambient temperatures are selecting for fungal strains with higher thermal tolerance, this could be expanding the pool of environmental fungi capable of establishing human infection. While this hypothesis remains under investigation, it highlights climate change as a potential driver of emerging fungal diseases—a concern with significant public health implications.