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.