Candida auris is a multidrug-resistant yeast that poses a disproportionate threat to transplant recipients because of prolonged hospitalizations, intensive immunosuppression, frequent invasive procedures, and exposure to broad-spectrum antimicrobials. Despite growing recognition of its propensity for skin colonization, environmental persistence, and biofilm formation on healthcare devices, standardized screening practices for transplant donors and recipients remain poorly defined. Herein, we review published outbreak reports, surveillance studies, laboratory guidance, and public health recommendations to synthesize current approaches to C. auris screening relevant to transplant populations. Key domains included risk-based criteria for admission and response screening, diagnostic modalities (culture, chromogenic media, MALDI-TOF, and real-time PCR), and the applicability of ICU-derived data to transplant settings. Screening strategies include targeted admission or outbreak-driven response. Culture-based methods remain widely used but are slower and require confirmatory testing, whereas molecular assays enable rapid detection with high sensitivity and specificity and permit timely infection-control responses. Much of the data is extrapolated due to a paucity of transplant-specific evidence; available reports suggest frequent colonization in critically ill transplant recipients and high mortality among those who develop invasive disease. No validated decolonization protocols exist, and perioperative screening is not addressed in most guidelines, creating a gap in peri-transplant risk mitigation.Prospective, transplant-focused studies are needed to define optimal perioperative screening, quantify progression risk from colonization to invasive infection, and evaluate the clinical impact of screening on patient outcomes.

BackgroundInvasive fungal infections (IFIs) are associated with severe complications and high mortality, particularly in critically ill patients. Despite their clinical significance, the true burden of IFIs remains poorly understood in low- and middle-income countries (LMICs) like Bangladesh, primarily due to the lack of structured surveillance systems. This study aims to assess the burden of IFIs among patients admitted to critical care units in Bangladesh.Circulating fungal pathogens among neonatesMIC values of different antifungal for Candida auris and Candida blankii isolatesMethodsSince August 2022, hospital-based sentinel surveillance has been ongoing in the ICU, NICU, and PICU of two tertiary-level hospitals in Dhaka. By March 2025, a total of 829 patients with suspected IFIs were enrolled based on predefined criteria. Blood and endotracheal aspirate samples were processed using microscopy, culture, and identification via Vitek 2 and Vitek MS systems. Antifungal susceptibility testing (AFST) was performed using E-test methods for selected isolates.ResultsOverall, 35% of the enrolled patients had fungal-positive blood cultures, though positivity varied by unit. Adult ICUs showed 7.5% positivity (n=351), with Candida auris and Candida tropicalis (6 each) being predominant. PICUs demonstrated 31% positivity (n=123), mostly infected with Candida blankii (18). NICUs revealed the highest burden (60%, n=355), with C. blankii (107) and Kodamaea ohmeri (61) as predominant species. Empirical antifungal use, particularly fluconazole and voriconazole, was common (26%); however, high azole resistance was noted, especially in C. auris and C. blankii and was associated with higher mortality.ConclusionThere is significant IFI burden in critical care units of Bangladesh with frequent identification of emerging and resistant pathogens. These findings highlight the urgent need for affordable diagnostics, standardized AFST protocols, and incorporation of IFI-specific strategies into antimicrobial stewardship programs to ensure rational anti-fungal use and curb resistance.DisclosuresAll Authors: No reported disclosures

The human fungal pathogenCandidozyma auris (formerly Candida auris) can cause prolonged infection outbreaks with high mortality rates in healthcare settings. Treatment failures of patients arise not only from antifungal drug resistance, but also from intra-species variability in pathogenicity as well as induced hypermutation events in response to clinical therapy. Whole genome sequencing was used to identify genetic mutations using the CDC mycoSNPs pipeline. Antifungal susceptibility testing was performed based on Clinical and Laboratory Standards Institute (CLSI) methods. We report here that the interlaboratory exchange ofC. aurisclinical isolates dried on sterile filter paper, resulted in the emergence of at least three distinct morphotypes following reconstitution. These distinct morphotypes exhibited differences in drug resistance and morphogenesis, linked to the accumulation of mutations in genes associated with azole and echinocandin resistance. Using whole genome sequencing, we identified several variants inTAC1B,MRR1andFKS2that correlate with altered drug susceptibilities. Experiments recapitulating filter paper shipment conditions revealed genetic and epigenetic changes, explaining the morphogenetic switching and altered azole resistance. Our findings demonstrate thatC. auriscan acquire mutations affecting drug resistance traits even in the absence of antifungal exposure, raising concerns about shipment preparation procedures across mycology laboratories. The results are of broad relevance for the medical mycology community, as they call for standardized protocols for exchanging clinical strains, but also experiments to verify phenotypic traits between laboratories.ImportancePathogenesis and antifungal drug resistance traits ofCandida aurisvary widely across clinical strains and are often attributed to elevated mutation rates. In fungal pathogen research, clinical strains are commonly exchanged between laboratories by transfer on filter paper, a convenient and widely used practice. However, in the case of aC. aurisclinical strain received from a collaborating laboratory, we identified multiple acquired mutations. These genetic alterations caused marked changes in morphogenesis and antifungal susceptibility, demonstrating that resistance inC. auriscan arise without antifungal selection pressure. Our findings highlight the potential for genetic and phenotypic diversification during routine strain handling and underscore the need for standardized protocols for exchanging clinicalC. aurisstrains across mycology laboratories.

Candida auris is an emerging, multidrug-resistant fungal pathogen associated with severe infections, nosocomial outbreaks, and high mortality rates. Although its global prevalence is increasing, epidemiological and clinical data from Vietnam remain limited. This study provides the first characterization of C auris infections in Vietnam, highlighting clinical features, antifungal susceptibility, and outcomes to address a critical knowledge gap and inform local practice. A retrospective study was conducted at the Department of Pulmonary Medicine, Cho Ray Hospital, Vietnam, from January 2023 to July 2025. Adult patients (≥18 years) with confirmed C auris infection, identified from clinical specimens by MALDI-TOF MS, were included. Demographic, clinical, and microbiological data were extracted from medical records. Antifungal susceptibility was assessed using the ETEST method and interpreted according to the CDC breakpoints. Outcomes were defined as survival versus mortality at discharge. Statistical analyses were performed using STATA 15.1, with significance set at P < .05. Twenty-two patients were identified, with a median age of 67 years and 77.3% male. Most (81.8%) required intensive care, and all had underlying lung disease with pneumonia. The overall survival rate was 59.1%. Mortality was significantly associated with parenteral nutrition, malnutrition, hypoalbuminemia, and vasopressor use (P < .05). Survivors more frequently exhibited co-isolation with non-auris Candida species (P < .05). Antifungal susceptibility testing showed that most isolates remained sensitive, with fluconazole susceptibility observed in 86.4% of cases. This study represents the first report of C auris infections in Vietnam, demonstrating its clinical burden in patients with severe respiratory illness. Early detection, appropriate antifungal therapy, and nutritional optimization appear crucial for improving outcomes. Routine surveillance and larger multicenter studies are warranted to guide infection control and evidence-based management of C auris in resource-limited settings.

Astragalus membranaceus polysaccharide (APs) and Eugenol: Multi-target Anti-inflammatory, Antioxidant, Antimicrobial, and anticancer effects validated by in Silico studies

Intracranial Candida Auris Infection: A Case Report and Scoping Review.

The oxidative stress-related peroxiredoxin Tsa1b of Candidozyma (Candida) auris contributes to virulence and infection.

How to interpret MICs of amphotericin B, echinocandins and flucytosine against Candida auris (Candidozyma auris) according to the newly established European Committee for Antimicrobial Susceptibility Testing (EUCAST) breakpoints.

Detection of Candidozyma (formerly Candida) auris from ward wastewater during an outbreak using culture and molecular methods.

Candidiasis: a novel molecular differential diagnosis through real-time PCR followed by high-resolution thermal denaturation.

Differential susceptibility of Candida (Candidozyma) auris clades to surface disinfectants.

Introduction: Candidemia has emerged as a major cause of bloodstream infections in Indian hospitals, contributing substantially to morbidity, mortality, and healthcare costs. Over the past two decades, a distinct epidemiological transition from Candida albicans to non-albicans Candida (NAC) species has been observed, accompanied by rising antifungal resistance and the emergence of Candida Auris as a multidrug-resistant pathogen. Objective: To synthesize evidence from Indian studies on the epidemiology, species distribution, antifungal susceptibility, and clinical outcomes of candidemia across adult, pediatric, and neonatal populations. Methods: A narrative review was conducted using PubMed, Scopus, Ended, and Google Scholar for English-language publications from 2000–2024. Studies describing laboratory-confirmed candidemia in India were included and analyzed for regional trends, resistance profiles, and patient outcomes. Results: Across more than three decades of surveillance, C. tropicalis and C. parasitosis have replaced C. albicans as predominant isolates, particularly in intensive-care, oncology, and neonatal settings. Fluconazole resistance among NAC species is increasing, while C. auris demonstrates multidrug resistance and frequent ICU-associated outbreaks. Reported mortality rates range from 30 to 60 percent, highest in neonates and immunocompromised patients. Delayed diagnosis, empirical azole use, and limited antifungal stewardship amplify disease burden. Conclusion: Candidemia in India represents an evolving public-health challenge driven by NAC predominance and escalating antifungal resistance. Strengthening mycology laboratories, incorporating species-level identification, and integrating fungal surveillance into national AMR programs are imperative for early detection, rational therapy, and improved patient survival.

Piper betle leaf (betel leaf) has been traditionally used in Southeast Asian medicine to treat ailments such as sore throat, skin abscesses, and digestive disorders. Modern research has demonstrated that the leaf contains a wide range of bioactive compounds, including phenolic acids and essential oils such as eugenol, chavicol, and chavibetol, which possess notable antibacterial, antifungal, anti-inflammatory, antioxidant, and potential anticancer properties. This study evaluated the total phenolic content, flavonoid content, the tannin presence of the aqueous extract obtained from fresh young P. betle leaf using a heat-assisted extraction method as well as the antifungal efficacy of that extract. The antifungal activity was evaluated against two opportunistic yeast strains: Candida albicans, a representative of spoilage yeasts in food and dairy products, and Candida auris, a multidrug-resistant species. Antifungal activity was assessed in-vitro using the agar well diffusion method, and the extract exhibited inhibition zones diameter ranging from 1.37 &amp;plusmn; 0.06 cm to 2.23 &amp;plusmn; 0.06 cm, indicating clear growth suppression. The minimum inhibitory concentration (MIC) of the extract was determined to be 32 mg dry weight equivalent per mL of extract for C. albicans and 64 mg/mL for C. auris. The total phenolics and flavonoid content were 131.06 &amp;plusmn; 2.92 &amp;micro;g GAE/mg and 8.48 &amp;plusmn; 0.19 &amp;micro;g QUE/mg dry weight basis, respectively. Tannin was also found in betle leaves extract, indicated by the presence of a brownish green color when reacted with FeCl₃ . These findings suggested that aqueous extracts of P. betle leaves offered promising antifungal properties against both foodborne and clinically relevant yeasts. The use of water as a solvent not only ensured safety and compatibility with food systems but also supported the development of sustainable, plant-based antifungal agents. Overall, this study contributes to the growing body of evidence supporting the application of traditional medicinal plants in modern food preservation, with P. betle offering a viable natural alternative to synthetic antifungal compounds.

Candida auris (Candidozyma auris, C. auris) is a significant concern in infection prevention. This study aims to analyze the antifungal susceptibility of C. auris isolates and risk factors of C. auris-associated infections in hospitalized patients at a tertiary care hospital in China, providing evidence to guide infection control strategies and effectively prevent in-hospital transmission. A retrospective analysis was conducted to evaluate the quarterly trends in newly identified Candida isolates from January 1, 2022, to March 31, 2025. Antifungal susceptibility profiles of C. auris were assessed and compared with those of other Candida species. In addition, the clinical characteristics of hospitalized patients infected with C. auris were analyzed and compared to those of patients infected with other Candida species. The number of newly identified C. auris infections demonstrated an upward trend over the study period. In our hospital, C. auris showed a fluconazole resistance rate of 77.42% and an amphotericin B resistance rate of 3.23%. Patients with C. auris infection had a significantly longer median hospital stay [17 (14–25) days] compared to those infected with other Candida species [12 (7–19) days] (p < 0.001), as well as a significantly higher mortality rate (p < 0.001). A multivariable regression analysis of Candida infections showed that intensive care unit admission (OR 1.502, 95% CI 1.273–1.923), hypertension (OR 1.476, 95% CI 1.207–1.807), immunosuppressive status (OR 1.179, 95% CI 1.036–1.483), and the presence of indwelling medical devices (OR 1.265, 95% CI 1.065–1.422) were all independently associated with infection risk, with statistical significance (p < 0.05). Ongoing vigilance is warranted for fluconazole-resistant C. auris, and stringent implementation of infection prevention and control measures remains essential to limit its spread and impact in healthcare settings.

Candidozyma auris (syn. Candida auris) is a hazardous multi-drug resistant yeast that causes severe infections in hospitalized patients. Many uncertainties exist around its antifungal resistance, clinical presentation, dominant clade, and isolation sites in the European setting. Therefore, to properly assess these characteristics, we systematically reviewed case reports in Europe between the first case described in 2009 and January 2023. We conducted this systematic review according to the PRISMA guidelines. Cases of both symptomatic and asymptomatic patients have been included. We extracted patients' demographics, C. auris isolation site, identified clade, clinical presentation, clinical outcome, as well as treatment. The case reports have been assessed for quality using standardized tools. Out of 251 identified articles, 12 reports from 10 European countries describing 15 cases are included In the review. The youngest affected person was an infant and the oldest was 74 years old. Blood was the most common isolation site, reported in 26% of reported cases. The fatality rate could not have been reported due to the high number of asymptomatic patients and comorbidities or other infections in symptomatic patients. About 91% of reported isolates were resistant to fluconazole, 18% to amphotericin B and none was resistant to echinocandins. The quality assessment revealed that about 33% of case reports had a high risk of bias. Our results show that any age group can be affected. The antimicrobials of choice in the European setting seem to be the echinocandins, although proper standardized susceptibility breakpoints are needed.

Clinical Features and Antifungal Resistance in Candidozyma (Candida) auris Bloodstream Infections: Experience from a Tertiary Intensive Care Unit in Türkiye

Distribution and Antifungal Susceptibility of Candida auris Isolates from Clinical Samples in a Tertiary Care Hospital: A Four-Year Retrospective Study

The pronounced skin tropism and pan-antifungal resistance of Candida auris pose a serious global health threat. A key question in C. auris biology is how clinical isolates acquire amphotericin B resistance. Here we demonstrate that a carbonic sensing pathway (CSP) contributes to amphotericin B resistance by modulating mitochondrial energy functions in clinical C. auris isolates. Integrated transcriptomics and proteomics identify the carbonic anhydrase Nce103 and its transcription factors Rca1 and Efg1 as important regulatory components of the CSP. The conversion of CO2 into bicarbonate sustains energy metabolism required for colonization and fitness on human skin and in nutrient-limited microenvironments. We also show that bacterial skin colonizers engage urease to release CO2 that sustains C. auris fitness and skin colonization. These findings highlight therapeutic options to re-sensitize C. auris to antifungal treatments, as well as to prevent skin colonization by blocking the CSP.

Reaffirming the importance of nomenclature stability for Candida auris and its associated disease of candidiasis.

Candida auris is an emerging multidrug-resistant fungal pathogen posing serious global healthcare challenges due to its persistence, frequent misidentification, and resistance to all major antifungal drugs. This study aimed to explore natural therapeutic alternatives by investigating the antifungal and molecular properties of Moringa peregrina and Moringa oleifera leaf extracts. Ethanolic and aqueous extracts of both Moringa species were prepared and evaluated against C. auris and other Candida species (Candida spp.) using zone of inhibition (ZI), minimum inhibitory concentration (MIC), and minimum fungicidal concentration (MFC) assays. Phytochemical composition was characterized through fourier transform infrared spectroscopy (FTIR) and gas chromatography–mass spectrometry (GC–MS) analyses, while cytotoxicity on mammalian MCF-7 cells was assessed using the MTT assay. Molecular docking and 100-ns molecular dynamics simulations were conducted to examine the binding of key bioactive compounds to C. auris dihydrofolate reductase (DHFR; PDB: 8CRH). Ethanolic extracts exhibited the strongest antifungal activity (ZI: 16–16.5 mm; MIC: 0.5–0.7 mg/mL), whereas aqueous extracts were comparatively less effective. FTIR spectra revealed prominent peaks corresponding to hydroxyl (O–H), carbonyl (C = O), and C–O functional groups, confirming the presence of alcohols, esters, phenols, and carboxylic acids, while GC–MS identified β-sitosterol, stigmasterol, dihydroxanthin, and vitamin E derivatives as predominant constituents. Docking results revealed high binding affinities for vitamin E (− 86.6 kcal/mol) and stigmasterol (− 83.5 kcal/mol), exceeding that of fluconazole (− 27.3 kcal/mol). Molecular dynamics confirmed stable protein–ligand complexes, with hydrophobic and van der Waals forces dominating the interactions. Cytotoxicity assays revealed low toxicity at antifungal concentrations (IC₅₀ ≥ 120 µg/mL). These findings demonstrate that Moringa extracts—particularly the ethanolic fractions—harbor potent bioactive compounds with promising antifungal activity against C. auris, highlighting their potential as novel, plant-derived therapeutic candidates to combat resistant fungal infections.