The multidrug-resistant yeast Candida auris, also known as Candidozyma auris, is rapidly spreading across European hospitals. The European Centre for Disease Prevention and Control (ECDC) has reported more than 4000 cases since 2013, including 1346 cases by 2023. Experts have urged stronger surveillance and mandatory reporting of all laboratory-confirmed cases to curb the spread of the disease.

At a press conference, Diamantis Plachouras, MD, PhD, who leads the ECDC’s Antimicrobial Resistance and Healthcare-Associated Infections section, called the trend “worrying” and the numbers “alarming.”

Germany has reported 120 cases over the past decade, placing it among the higher-burden countries in Europe, after Spain, Greece, Italy, and Romania.

Oliver Kurzai, MD, director of the Institute for Hygiene and Microbiology at Julius-Maximilians-Universität Würzburg, Würzburg, Germany, and head of the National Reference Center for Invasive Fungal Infections, stressed that “no patient needs to worry; Candida auris is currently a rarity in Germany,” adding that the situation is epidemiologically concerning but the risk for individual patients remains low.

Birgit Willinger, MD, head of Clinical Microbiology, Medical University of Vienna, Vienna, Austria, noted that the findings should raise awareness rather than cause panic, while Tim Eckmanns, MD, head of the Department for Healthcare-Associated Infections, Robert Koch Institute in Germany, urged action: “Take care of this fungus.”

Rising Concern

Cases of C auris have been known since 2009, with the first documented case identified in Japan as an ear infection. The organism is resistant to many standard antifungals, adheres strongly to surfaces, and, unlike most other Candida species, can spread from person to person, as Willinger noted.

Invasive infections mainly affect patients with serious underlying conditions, and early outbreaks can occur in organ transplant recipients. This organism is endemic to India.

In Germany, C auris has been subject to mandatory notification since 2023, but currently only for invasive infections, Eckmanns said.

A proposal is under discussion to extend the notification to all laboratory-confirmed detections, which is considered sensible and desirable by measurement experts. Immediate action is important in every infection because C auris can also be transmitted by colonised asymptomatic individuals.

Transmission Risks

Transmission usually occurs via contaminated equipment or surfaces and often indirectly from colonised or infected patients. Kurzai explained: “The most important transmission vehicles are medical devices used directly on patients, such as temperature probes or bronchoscopic spatulas, which are difficult to disinfect.”

Those at the highest risk include immunocompromised patients, older adults, and people in ICUs, with infections presenting as bloodstream infections that can lead to sepsis or organ dissemination or as device-associated infections involving prostheses or catheters. In Germany, approximately 20% of reported cases are infections, and 80% are colonisations.

Outlook

“Overall, the situation in Germany is still relatively well under control. We can slow and contain the spread,” Kurzai said. “Germany appears at a higher level in the ECDC framework primarily because case documentation is nearly complete; many countries likely see only the tip of the iceberg.

Work with the Robert Koch Institute suggests we capture about 80% of all cases, so the number of unreported cases is low — unlike in Spain, Italy, or Greece.” Eckmanns stated that the situation remains manageable for now but warned that as prevalence rises, antifungal resistance will increase, and case numbers are likely to grow.

“Candida auris is the first and most prominent example among fungi, but other pathogens are likely to follow,” Kurzai added.

Fungi adapt to higher temperatures, and one hypothesis is that C auris acquired human infectivity in this way. Willinger noted that the COVID-19 pandemic accelerated transmission because overwhelmed healthcare systems were less able to contain it and emphasised the need to slow the spread to preserve antifungal therapies.

“In Germany, most C auris isolates remain susceptible; few have developed resistance to echinocandins during treatment, but these are isolated cases,” Kurzai said.

Several antifungal agents are in the latest stages of clinical development, with large multicentre efficacy trials underway, and some are already available through expanded access or compassionate use programs.

Experts agree that sustained education and expanding mandatory notifications to all confirmed cases are essential to curb further spread.

This story was translated from Medscape’s German edition.