Candida auris: a review of global epidemiology, multidrug resistance, and infection control in healthcare-associated outbreaks

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Candida auris , designated a critical-priority fungal pathogen by the World Health Organization, poses a growing threat to healthcare systems worldwide. Analysis of 80 peer-reviewed studies reveals five principal findings: (1) C. auris exhibits clade-dependent geographic distribution and resistance profiles—Clade I (South Asia) and Clade III show fluconazole resistance exceeding 90%, whereas Clade IV exhibits 44% resistance; echinocandin resistance varies significantly by clade and no resistance was detected in certain clades; amphotericin B resistance varies from no detected resistance to 46% depending on clade; and pan-resistant strains have emerged; (2) biofilm-associated C. auris cells (sessile cells) exhibit MBECs 2- to 4,119-fold higher than planktonic MICs, representing a major driver of persistent colonization; (3) novel antifungal agents, including ibrexafungerp, manogepix (the active moiety of fosmanogepix), and rezafungin, demonstrate promising in vitro activity against C. auris , with manogepix showing the highest overall antibiofilm activity (geometric mean MBEC of 5.9 μg/mL) and ibrexafungerp demonstrating superior activity against Clade IV biofilms; (4) a tiered infection prevention and control (IPC) framework—integrating universal screening, contact precautions, and environmental decontamination—has been associated with reduced transmission rates in outbreak settings; and (5) climate change and global warming may have contributed to the emergence of C. auris through thermal adaptation of environmental fungal species. These findings indicate that effective mitigation of the C. auris threat requires integrated surveillance, susceptibility-guided therapy accounting for both planktonic and biofilm activity, and resilient healthcare systems adapted to the clade-specific epidemiology of this pathogen.