Candida auris: Drug-Resistant Fungus Spreads in U.S. Healthcare Facilities, CDC Reports
Key Insights
CDC data show Candida auris (search) cases rose from 2,882 in 2022 to 6,197 in 2024, with bloodstream infections increasing approximately 60% over the same period.
Some strains have developed resistance to all classes of antifungal medications, including first-line echinocandins (search), raising alarm among infectious disease experts.
The risk to the general public remains low, but the fungus poses a serious threat to chronically ill patients in hospitals and nursing homes, with estimated mortality of 30–60%.
Federal health officials are raising alarms over the accelerating spread of Candida auris (search), a multidrug-resistant fungal pathogen that has established a growing foothold in U.S. healthcare facilities. According to data from the Centers for Disease Control and Prevention (search) (CDC), reported cases have climbed sharply, from 2,882 nationwide in 2022 to 4,428 in 2023 and 6,197 in 2024. More than 3,000 cases have already been documented across 23 states so far this year, with Texas (706 cases), Michigan (503), and Illinois (366) reporting the highest burdens.
The rise in cases reflects both increased transmission and expanded surveillance. The CDC distinguishes between clinical cases—where the fungus is detected during workup for suspected infection—and screening cases, identified by swabbing patients to check for colonization. Because colonization can precede infection, a single patient may count in both categories. Both totals rose steeply between 2022 and 2024, though the CDC acknowledges it cannot apportion the increase precisely between more frequent infections and more intensive looking.
Bloodstream infections, which represent unambiguous invasive disease, rose approximately 60% across the two years, from 991 to 1,586 cases. This metric offers a more conservative and reliable measure of disease growth than the headline doubling of all clinical cases combined, since non-blood specimens—urine, wounds, and respiratory tract samples—often reflect colonization rather than serious infection.
A Pathogen Unlike Typical Candida
Candida auris (search), first identified in Japan in 2009 and reported in the United States in 2016, behaves differently from more familiar Candida species. “It is often multidrug-resistant, so some antifungals may not be reliable as in other Candida species. It can also persist in healthcare environments, making it difficult to eradicate,” said Peter Chin-Hong, MD, professor of medicine at the University of California San Francisco.
The fungus is a type of yeast capable of entering the bloodstream and disseminating throughout the body. It can survive on surfaces for weeks, spreading via contaminated medical equipment, furniture, and person-to-person contact. Transmission typically occurs through catheters, breathing tubes, or IVs in healthcare settings. A person may remain capable of transmitting the organism for months after clinical recovery.
Susan Huang, MD, professor of infectious diseases at the University of California Irvine School of Medicine, noted that the United States saw a doubling of positive screening cultures, from 6,000 to 12,000, between 2022 and 2024. “The rapid emergence around the world and the speed of spread in the U.S. is alarming,” Huang said. “The public should definitely be aware of this concern and how it may impact them or those they care about.”
Resistance and Treatment Challenges
Perhaps the most troubling feature of Candida auris (search) is its capacity to evade antifungal therapy. Nearly every isolate already defeats fluconazole, and some strains have developed resistance to all classes of medications normally used to treat fungal infections, including the echinocandins (search), which are the standard first-line treatment. When resistance is encountered, clinicians may prescribe high doses of multiple antifungal agents.
William Schaffner, MD, an infectious disease expert at Vanderbilt University, underscored the clinical implications: “This fungus is challenging to treat because it is developing resistance to commonly used antifungal drugs, making the prevention of infection even more important.”
Researchers estimate that 30–60% of people with Candida auris (search) illnesses have died, though many had other serious conditions that also increased their mortality risk.
Who Is at Risk
The burden of disease falls overwhelmingly on older, chronically ill populations. CDC data indicate that 88% of clinical cases occurred among people ages 45 and older, and the majority of cases were in males—a predominance that remains unexplained. Most cases occur in acute care facilities.
People with diabetes, blood cancers such as leukemia and lymphoma, and conditions that weaken the immune system face elevated risk of serious illness. Those residing in nursing facilities or experiencing frequent hospitalizations are at even higher risk. Experts emphasize that healthy individuals generally recover from Candida auris (search) on their own and that the pathogen is not circulating in the community.
“It is not a problem among the general public,” Schaffner said. Huang concurred: “C. auris is not circulating in the community, so those outside healthcare facilities are unlikely to be exposed.”
Infection Control and Shifting Screening Patterns
The geography of screening has shifted notably. In 2022, long-term acute care hospitals accounted for 56% of screening detections and ordinary acute care hospitals for 25%. By 2024, those proportions had inverted to 36% and 51%, respectively—likely reflecting hospitals adopting admission screening that catches patients colonized elsewhere.
The CDC suggests that the slowing rate of year-over-year increases—from 96% between 2021 and 2022 to 54% and then 40%—may reflect a return to standard infection-control practices as pandemic-era strains on staffing and supplies eased.
Experts stress that rigorous, unglamorous measures remain the cornerstone of containment. “Medical facilities pay special attention to rigorous disinfection of the patient care environment because C. auris can be found on high-touch surfaces. Identifying infected patients and caring for them in an isolation room is also important to curtail spread,” Schaffner said.
Chin-Hong outlined a comprehensive approach: “Other interventions include good hand hygiene, gowns, and gloves for patient care, thorough cleaning with the right disinfectant of rooms and shared equipment, clear signage denoting Candida auris (search) infection outside a patient’s room, and communication during transfers to other facilities.” He added that medical facilities should invest in laboratories capable of rapidly identifying Candida auris, as older methods may misidentify it.
Huang emphasized that prevention extends beyond the hospital walls: “The best way to prevent antibiotic-resistant pathogens from spreading further is to ensure that proper hand hygiene is practiced whenever visiting a healthcare setting or when helping a loved one with a wound or medical device at home.”