Candidozyma auris in Intensive Care Units: A Point Prevalence Study and Six-Month Colonization–Infection Surveillance

Candidozyma auris in Intensive Care Units: A Point Prevalence Study and Six-Month Colonization–Infection Surveillance | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Candidozyma auris in Intensive Care Units: A Point Prevalence Study and Six-Month Colonization–Infection Surveillance Reyhan Yiş, Güneş Şenol This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8854588/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Candidozyma auris has emerged as a globally significant nosocomial pathogen due to its multidrug antifungal resistance, environmental persistence, and high mortality rates. This study aimed to determine the prevalence of C. auris colonization through a point prevalence screening in the intensive care units (ICUs) of our hospital and to evaluate colonization and infection outcomes during a subsequent six-month follow-up period. Objectives: The present study aimed to evaluate C. auris colonization rates through point prevalence screening in the ICUs of our hospital, to assess colonization and infection outcomes during a subsequent six-month follow-up period, and to establish a diagnostic algorithm for C. auris identification in our laboratory. Methods: Following the detection of an index C. auris case in our hospital in February 2025, a point prevalence study was conducted in all ICUs. Composite swab samples (bilateral axilla and groin) were obtained from hospitalized patients on the same day. In addition, urine and wound cultures were collected from eligible patients. Isolates were identified using chromogenic media, conventional microbiological methods, and MALDI-TOF MS. After the point prevalence study, surveillance for colonization and bloodstream infection was performed over a six-month period. Results: C. auris colonization was detected in 7 of 70 ICU patients (10%) based on composite swab samples. During the six-month follow-up, colonization was identified in 15 patients, and C. auris fungemia developed in nine patients. All patients with positive blood cultures died. The most frequently identified risk factors were broad-spectrum antibiotic use, prolonged ICU stay, and the presence of urinary catheters. Conclusion: Our findings demonstrate that C. auris colonization can be detected at a high rate in intensive care units and that severe invasive infections may develop following colonization. Early diagnosis, active screening strategies, and effective infection control measures are critical for reducing C. auris -associated morbidity and mortality. Candidozyma auris Candida auris Intensive Care Units Colonization Bloodstream Infection Infection Control 1. BACKGRAUND Infections caused by Candida species are among the leading causes of morbidity and mortality in critically ill patients. Over the past decade, their incidence has increased progressively, largely due to the growing number of invasive medical procedures, widespread use of broad-spectrum antimicrobial agents, and the rising population of immunosuppressed critically ill patients. Although Candida albicans remains the most frequently isolated species, the prophylactic and extensive use of antifungal agents has led to a marked epidemiological shift toward non-albicans Candida species with reduced susceptibility or resistance to azoles and echinocandins. In recent years, Candida auris has emerged as a globally significant nosocomial pathogen. This multidrug-resistant (MDR) yeast exhibits resistance to fluconazole and variable susceptibility to other azoles, amphotericin B, and echinocandins. Due to its ability to cause severe outbreaks and its extensive intrinsic and acquired antifungal resistance, C. auris is considered a major global public health threat [ 1 ]. Since its first isolation in 2009 from an external ear canal drainage specimen of a patient in Japan, C. auris has been recognized as a novel fungal pathogen capable of causing deep-seated infections and fungemia, particularly in high-risk populations [ 2 , 3 ]. In 2022, the World Health Organization included C. auris in its list of fungal pathogens of “critical priority” [ 4 ]. More recently, based on a genome-scale phylogenetic analysis, Candida auris and related species have been reclassified into the newly established genus Candidozyma [ 5 ]. C. auris is also notable for being the first fungal pathogen designated as an urgent public health threat by the Centers for Disease Control and Prevention (CDC) [ 6 ]. Following its detection in patients in the United States in 2016, the CDC issued an alert emphasizing mandatory notification to clinicians, laboratories, and public health authorities upon identification of C. auris [ 7 ]. Beyond antifungal resistance, C. auris is particularly concerning due to its association with high mortality rates, especially among immunocompromised patients. Unlike other Candida species, C. auris demonstrates remarkable resistance to commonly used surface disinfectants, possesses a strong biofilm-forming capacity, and exhibits thermotolerance and osmotolerance [ 8 ]. These virulence-enhancing characteristics facilitate its persistence in hospital environments and enable transmission through invasive medical procedures, wounds, or medical devices via breaches in skin or mucosal barriers. C. auris has the capacity to colonize multiple body sites, including the skin, mucosa, respiratory tract, and bloodstream, and may subsequently cause invasive infections in vulnerable patients. Prolonged colonization of patients’ skin and mucosa, as well as environmental persistence within healthcare settings, significantly contribute to intra- and inter-facility transmission [ 9 , 10 ]. Although colonization is the predominant manifestation, candidemia typically follows colonization and is associated with mortality rates reaching up to 70% [ 4 ]. The cornerstone of prevention and control of C. auris infections includes rapid identification of colonized patients, strict adherence to contact precautions, and effective environmental cleaning [ 9 ]. The CDC recommends screening high-risk patients for C. auris colonization using composite swab samples obtained from the bilateral axilla and groin regions [ 11 ]. Patients with epidemiological links to confirmed cases, prior healthcare exposure, current hospitalization, or known risk factors for colonization are considered high-risk populations. Consequently, screening for C. auris is strongly recommended for patients hospitalized in intensive care units (ICUs), who are inherently at increased risk for candidiasis [ 12 ]. In Türkiye, the Ministry of Health General Directorate of Public Health has similarly recommended active screening strategies in healthcare institutions to identify patients colonized with C. auris [ 13 ]. Early identification of colonized or infected individuals is critical for guiding isolation measures and implementing infection control interventions, including disinfection of the patient’s immediate environment, to prevent further transmission. Following the detection of C. auris growth in a urine culture obtained from a patient in the Coronary ICU of our hospital in February 2025, the Infection Control Committee initiated a point prevalence study to assess the extent of C. auris colonization within the institution. Composite swab samples were collected from ICU patients to determine colonization rates. 2. OBJECTIVES The present study aimed to evaluate C. auris colonization rates through point prevalence screening in the ICUs of our hospital, to assess colonization and infection outcomes during a subsequent six-month follow-up period, and to establish a diagnostic algorithm for C. auris identification in our laboratory. 3. METHODS 3.1. Study Design and Patient Population This study comprised a cross-sectional point prevalence survey conducted in the intensive care units (ICUs) of a tertiary-care hospital, followed by a six-month observational surveillance period. After the detection of C. auris growth in a urine culture obtained from a patient hospitalized in the Coronary ICU in February 2025, the hospital Infection Control Committee decided to perform a point prevalence study to assess the extent of C. auris colonization across all ICUs. All patients hospitalized in the ICUs on the day of the point prevalence survey were included in the study. Accordingly, a total of 70 patients hospitalized in the following units were evaluated: Anesthesia ICU (AICU; n = 10), Internal Medicine ICU (IMICU; n = 9), General ICU-1 (GICU-1; n = 8), General ICU-2 (GICU-2; n = 12), General ICU-3 (GICU-3; n = 9), Chest Diseases ICU (n = 7), Cardiovascular Surgery ICU (n = 1), Coronary ICU (n = 8), and Neurology ICU (n = 6). 3.2. Sampling and Screening Strategy As part of the point prevalence study, composite swab samples were obtained on the same day from all patients by swabbing the bilateral axilla and groin areas. In addition, urine cultures were collected from patients with indwelling urinary catheters via Foley catheter sampling, and wound swab specimens were obtained from patients with open wounds. In total, 157 clinical specimens were submitted to the Microbiology Laboratory, including 70 composite screening swabs, 69 urine samples, and 18 wound swab specimens. Following the point prevalence study, routine colonization screening and blood culture results were monitored for a period of six months in patients hospitalized in the ICUs. During this follow-up period, composite swab samples were collected from newly admitted ICU patients to assess C. auris colonization status. 3.3. Culture and Identification Methods Screening for C. auris was performed using CHROMagar™ Candida Plus (CHROMagar, France), a chromogenic medium on which C. auris produces light blue colonies with a characteristic blue halo, allowing differentiation from other related and unrelated yeast species. Composite screening swabs were inoculated onto CHROMagar™ Candida Plus and sheep blood agar plates and incubated at 35 °C for 24–48 hours. Urine and wound swab specimens were cultured on sheep blood agar and eosin methylene blue (EMB) agar media. All yeast-like colonies were initially evaluated using the germ tube test. Germ tube–negative isolates were further examined morphologically on cornmeal Tween 80 agar. Definitive identification of suspected isolates was performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). 3.4. Assessment of Infection and Risk Factors During the six-month surveillance period, patients with C. auris growth detected in blood cultures were classified as infection cases. In these patients, known risk factors—including broad-spectrum antibiotic use, presence of central venous catheters, mechanical ventilation, immunosuppression, history of surgical procedures, and other relevant clinical factors—were evaluated retrospectively. 3.5. Statistical Analysis Descriptive statistics were expressed as numbers (n) and percentages (%). Comparisons between groups were performed using the chi-square test or Fisher’s exact test for categorical variables, as appropriate. Differences in C. auris isolation rates according to specimen type were analyzed using the chi-square test. The association between colonization and subsequent infection was evaluated using odds ratios (ORs) with 95% confidence intervals (CIs). A p value of <0.05 was considered statistically significant. 3.6. Ethical Approval This study was approved by the Izmir Bakircay University Clinical Research Ethics Committee (Approval No: 2732, Date: 28.01.2026). As this study was conducted retrospectively and involved no direct patient intervention, informed consent was waived by the ethics committee. 4. RESULTS 4.1. Point Prevalence Survey Findings Composite screening swab samples obtained from a total of 70 ICU patients revealed Candidozyma auris growth in 7 patients, corresponding to a colonization prevalence of 10.0%. During the same period, C. auris was isolated from 1 of 69 urine culture specimens and from 2 of 18 wound swab specimens (Table 1). Table 1. Distribution of screened patients and Candidozyma auris growth according to intensive care unit and specimen type ICU No. of Patients Screening Swabs Urine Cultures Wound Cultures C. auris in Screening C. auris in Urine C. auris in Wound Anesthesia ICU 10 10 10 5 5 1 2 Internal Medicine ICU 9 9 9 3 - - - General ICU-1 8 8 7 2 1 - - General ICU-2 12 12 12 2 1 - - General ICU-3 9 9 9 6 - - - Chest Diseases ICU 7 7 7 - - - - Cardiovascular Surgery ICU 1 1 1 - - - - Coronary ICU 8 8 8 - - - - Neurology ICU 6 6 6 - - - - Total 70 70 69 18 7 1 2 Among the seven patients with C. auris detected in composite screening swabs, five showed growth exclusively in the screening swab samples. One patient had C. auris growth in both the composite swab and wound culture, while another patient demonstrated growth in all three specimen types (composite swab, urine culture, and wound swab) (Table 2). Table 2. Candidozyma auris positivity rates according to specimen type Specimen Type Positive / Total Positivity (%) Screening swabs 7 / 70 10.0 Urine cultures 1 / 69 1.4 Wound cultures 2 / 18 11.1 Overall 10 / 157 6.37 Five of the colonized patients were hospitalized in the Anesthesia ICU, one in General ICU-1, and one in General ICU-2. The highest colonization rate was observed in the Anesthesia ICU, where 5 of 10 patients (50%) were colonized. Colonization rates differed significantly among the ICUs (p = 0.0044). The positivity rates according to specimen type were 7/70 (10.0%) for composite screening swabs, 1/69 (1.4%) for urine cultures, and 2/18 (11.1%) for wound swab specimens. Although isolation rates varied among specimen types, the difference was not statistically significant (p = 0.0773). When all specimen types were evaluated collectively, the overall positivity rate was 6.37% (10/157). 4.2. Six-Month Colonization Surveillance During the six-month follow-up period after the point prevalence survey, C. auris colonization was detected in screening cultures from 15 patients. These patients were hospitalized in the following ICUs: Anesthesia ICU (n = 6), General ICU-1 (n = 2), General ICU-2 (n = 4), General ICU-3 (n = 2), and Chest Diseases ICU (n = 1). 4.3. Infection Rates and Clinical Outcomes During the same six-month surveillance period, C. auris was isolated from blood cultures of nine patients: General ICU-1 (n = 1), Anesthesia ICU (n = 2), General ICU-2 (n = 3), and General ICU-3 (n = 3). Among these nine patients, three had previously been identified as colonized. The risk of developing bloodstream infection was approximately 4.5-fold higher in colonized patients (3/7) compared with non-colonized patients (6/63) (odds ratio [OR] = 4.5; Fisher’s exact test, p = 0.045). The interval between detection of colonization and blood culture positivity was one day in one patient, nine days in another patient, and approximately two months in the third patient. In two of the nine patients with C. auris fungemia, recurrent bloodstream infection was observed despite antifungal therapy (amphotericin B in one patient and an echinocandin in the other). Recurrent episodes occurred 13 and 30 days after the initial isolation, respectively. All patients with positive blood cultures experienced fatal outcomes. 4.4. Risk Factors The most frequently identified risk factors among patients who developed C. auris fungemia were broad-spectrum antibiotic use (100%), prolonged ICU stay (100%), presence of urinary catheters (100%), and use of central venous catheters (88.9%). Mechanical ventilation was present in 55.6% of patients, and 66.7% had a history of parenteral nutrition. All patients were older than 65 years (Table 3). Table 3. Clinical characteristics and risk factors of patients with Candidozyma auris fungemia (n = 9) Risk Factor N % Broad-spectrum antibiotic use 9 100 Prolonged ICU stay 9 100 Urinary catheter 9 100 Central venous catheter 8 88.9 Mechanical ventilation 5 55.6 Parenteral nutrition 6 66.7 Surgical procedure 4 44.4 Blood transfusion 4 44.4 Immunosuppression 2 22.2 Steroid use 1 11.1 5. DISCUSSION This study presents the results of a point prevalence survey and a subsequent six-month observational surveillance conducted to evaluate the frequency of C. auris colonization and infection in the intensive care units of a tertiary-care hospital. Following the first identification of C. auris in our institution, this investigation provides valuable insight into the immediate colonization burden and short-term clinical outcomes associated with this emerging pathogen. C. auris is a recently emerged, multidrug-resistant yeast that has caused large-scale outbreaks in numerous countries worldwide and is now recognized as part of a complex of multidrug-resistant fungal pathogens [14]. One of the major challenges associated with C. auris is the difficulty of accurate identification using conventional microbiological methods. Misidentification has frequently been reported with species such as C. haemulonii , C. famata , C. sake , C. catenulata , Rhodotorula glutinis , and Saccharomyces cerevisiae [15]. Currently, advanced molecular techniques, including PCR-based methods and DNA sequencing, as well as MALDI-TOF mass spectrometry, are considered the gold standard for accurate identification of C. auris . MALDI-TOF MS, in particular, has demonstrated high accuracy and rapid turnaround time by detecting Candida ribosomal proteins and comparing them with reference spectra in established databases [15, 16]. In the present study, although the development of a cost-effective diagnostic algorithm incorporating conventional methods was initially considered, definitive identification was achieved using MALDI-TOF MS due to the lack of specific discriminatory features in traditional approaches. Given that MALDI-TOF MS is not universally available in all healthcare institutions, improving and validating conventional diagnostic strategies remains an important priority, especially for resource-limited settings. Accurate and timely identification of C. auris is essential for the initiation of appropriate antifungal therapy and the implementation of infection prevention and control measures. These interventions are particularly critical in limiting and controlling potential hospital outbreaks caused by a pathogen characterized by high mortality rates and limited therapeutic options. The present study contributes to this effort by evaluating screening results aimed at identifying patients colonized or infected with C. auris and assessing the effectiveness of infection control strategies. Guidelines for the management of C. auris colonization and infection have been published by the CDC, the European Centre for Disease Prevention and Control (ECDC), and the Turkish Ministry of Health [13, 17, 18]. Because C. auris is transmitted through close contact with colonized individuals or contaminated environments, screening is recommended for patients with recent healthcare exposure or epidemiological links to confirmed cases. Following the identification of the index case in the Coronary ICU of our hospital, a same-day cross-sectional screening of all ICU patients was performed to determine the institutional colonization burden. In this point prevalence survey, C. auris colonization was detected in 7 of 70 patients (10%). Additionally, C. auris was isolated from urine culture in one patient and from wound cultures in two patients. Among colonized patients, five had positive composite screening swabs only, while growth was detected in multiple specimen types in two patients. When compared with point prevalence studies conducted in other countries, the colonization rate observed in our study appears relatively high. Malik et al. [19] reported a colonization rate of 1.6% in a study involving 430 patients in the United States, whereas Harris et al. [20] identified a colonization rate of 6.6% in another U.S.-based point prevalence survey. In contrast, our colonization rate of 10% suggests a substantial colonization burden in ICU settings. Colonization rates reported from different regions vary widely. Studies from India have reported colonization rates as high as 21% among patients exposed to index cases, while St. Maurice et al. and Southwick et al. reported rates of 4.5% and 7%, respectively [21- 23]. Variations in colonization rates may be attributed to differences in patient populations, duration of ICU stay, intensity of invasive procedures, effectiveness of infection control practices, and screening strategies. The relatively high colonization rate observed in our study underscores the ability of C. auris to spread rapidly in ICU environments characterized by prolonged hospitalization and frequent invasive interventions. The isolate obtained from a urine culture in February 2025, which represented the first detection of C. auris in our institution, was designated as the index case. As this isolate originated from the Coronary ICU, the Infection Control Committee decided to include all ICUs in the point prevalence survey and subsequent screening program. Following the initial survey, routine screening of all newly admitted ICU patients using composite swab samples was implemented. Due to the variable duration of colonization, repeat screening was not performed for patients who tested positive, and routine screening has continued as planned. In addition to standard precautions, contact precautions are required for patients colonized or infected with C. auris [17,18]. Because transmission can occur via medical devices, these measures include the use of gloves and long-sleeved gowns, as well as patient-dedicated or single-use non-critical equipment. Placement of patients in single rooms is preferred; when not feasible, cohorting of patients with C. auris colonization or infection may be considered. In situations of limited staffing, cohorting of both patients and healthcare personnel may also be necessary [9, 24]. Accurate identification of colonized or infected patients is a prerequisite for the successful implementation of these measures. Colonization with C. auris may develop within hours or days after exposure and can persist for months without causing symptoms. Nevertheless, colonization places patients at risk for invasive infection, with approximately 5–10% of known colonized individuals developing invasive disease [25]. Invasive C. auris infections may occur days to months after colonization, particularly in patients with immunosuppression, significant comorbidities, indwelling central venous or urinary catheters, prior healthcare exposure, and recent antimicrobial therapy. Reported clinical manifestations include candidemia, catheter-related infections, soft tissue or wound infections, osteomyelitis, myocarditis, meningitis, and urinary tract infections [26, 27]. Nearly one-quarter of colonized ICU patients are reported to be at risk for developing C. auris bloodstream infections [28]. During the six-month follow-up period in our study, C. auris colonization was detected in 15 patients, indicating ongoing transmission and persistence within the ICU environment. Colonized patients were most frequently identified in the Anesthesia ICU and General ICUs, a finding that may be related to higher patient turnover, increased use of invasive devices, and more frequent administration of broad-spectrum antimicrobials in these units. The resistance of C. auris to disinfectants and its ability to survive on environmental surfaces for prolonged periods further contribute to its role as a persistent reservoir in ICU settings. The rapid emergence of multiple colonized patients following a single index case highlights this transmission potential. During the same six-month period, C. auris was isolated from blood cultures of nine patients, three of whom had previously been identified as colonized. The interval between colonization detection and bloodstream infection ranged from one day to two months. In two patients, recurrent fungemia occurred despite antifungal therapy with amphotericin B or echinocandins, suggesting that variable antifungal susceptibility and biofilm formation may adversely affect treatment outcomes. These findings emphasize the importance of antifungal susceptibility testing and, when feasible, investigation of molecular resistance mechanisms. The retrospective analysis of 912 patients with C. auris infections reported between 2009 and 2020 highlighted that male patients, premature infants, and elderly individuals were disproportionately affected. Consistent with previous studies, underlying comorbidities such as diabetes mellitus, renal disease, trauma, and otologic disorders were frequently observed. More than half of the patients had a history of central venous catheterization and broad-spectrum antibiotic exposure, supporting the notion that invasive procedures and antimicrobial pressure play a pivotal role in the pathogenesis of C. auris infections. Importantly, renal disease emerged as a significant risk factor for mortality, underscoring the need for careful monitoring and tailored management in this subgroup [29]. In our institution, all patients with C. auris growth in blood cultures shared similar risk factors, including broad-spectrum antibiotic use, prolonged intensive care unit stay, and urinary catheterization. The presence of hypertension in five patients and diabetes mellitus in four patients further reflects the burden of chronic comorbidities in this population. Interestingly, all patients were older than 65 years, and no statistically significant difference was observed between genders (5 female, 4 male), suggesting that advanced age rather than sex may be a more critical determinant of susceptibility. In our cohort, all patients with C. auris fungemia died, reflecting the severe clinical course associated with invasive C. auris infections in critically ill patients. However, it should be considered that mortality may not be solely attributable to C. auris infection but may also be influenced by advanced age, prolonged ICU stay, extensive comorbidities, broad-spectrum antibiotic exposure, and the presence of invasive devices. In our study population, all patients were older than 65 years and exhibited multiple risk factors known to be associated with increased mortality. An important strength of this study is the implementation of a diagnostic algorithm that integrates chromogenic media, conventional microbiological methods, and MALDI-TOF MS for C. auris identification. Given the high risk of misidentification using traditional techniques, the rapid and accurate identification provided by MALDI-TOF MS likely contributed to the timely initiation of infection control measures. Nevertheless, the limited availability of this technology highlights the need for the development of reliable and cost-effective screening algorithms suitable for broader implementation. This study has several limitations. The relatively short duration of follow-up and the limited number of patients reduce the generalizability of the findings. Longer-term and larger-scale studies are needed to better define risk factors and transmission dynamics. In addition, antifungal susceptibility testing and molecular epidemiological analyses were not included, precluding assessment of clonal relatedness among isolates. Despite these limitations, the study provides important evidence of C. auris presence within our institution and supports the strengthening of infection control strategies. 5.1. Conclusion In conclusion, C. auris colonization was detected at a rate of 10% in the point prevalence survey conducted in the intensive care units of our hospital, with a significantly higher prevalence observed in the Anesthesia ICU compared with other units. Colonized patients demonstrated a markedly increased risk of developing invasive infection. Among patients who developed infection, risk factors such as broad-spectrum antibiotic use, prolonged ICU stay, and the presence of invasive devices were highly prevalent. This study represents the first assessment of institutional exposure to C. auris in our hospital through a point prevalence approach. Colonization surveillance and infection outcomes during the subsequent six-month period were also evaluated. In parallel, a practical diagnostic algorithm for C. auris identification was assessed and implemented in our laboratory. The experience gained during this process highlights the critical importance of rapid microbiological diagnosis and the timely application of infection control measures. Overall, C. auris is a major nosocomial pathogen capable of rapid dissemination in intensive care units and of causing invasive infections associated with high mortality following colonization. Early identification, active screening strategies, and strict infection prevention and control measures play a pivotal role in limiting transmission. Future prospective studies involving larger patient populations and longer follow-up periods are needed to further clarify the clinical impact of C. auris colonization and infection. Declarations Author Contributions: Study concept and design: RY, GŞ Acquisition of data: RY Analysis and interpretation of data: RY Drafting of the manuscript: RY Critical revision of the manuscript for important intellectual content: RY, GŞ Statistical analysis: RY Administrative, technical, and material support: RY, GŞ Study supervision: RY, GŞ Ethics Approval and Consent to Participate: This study was approved by the local Ethics Committee (approval number: 2732, date: 28/01/2026). Informed consent was obtained from all individual participants included in the study. Consent to Participate: Informed consent was obtained from all individual participants included in the study. Funding: The authors declare that this study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Human Ethics and Consent to Participate declarations: Not applicable Conflict of Interest: The authors declare that they have no conflict of interest. References Jenks J, Tobin EH, Zahra F. Candida auris . [Updated 2025 Nov 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563297/ Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol. 2009;53(1):41-4. Meis JF, Chowdhary A. Candida auris : a global fungal public health threat. Lancet Infect Dis. 2018;18(12):1298-1299. 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[Accessed April 23, 2018]. ECDC, Stockholm. Available at https://www.ecdc.europa.eu/sites/default/files/documents/RRA-Candida-auris-European-Union-countries.pdf Malik A, Shallal A, Ruby A, Malm J, Mclenon J, Shanahan C, et al. P-361. Outcome of Candida auris Point Prevalence Survey in a Tertiary Care Hospital in Southeast Michigan. Open Forum Infect Dis. 2025;12(Suppl 1):ofae631.562. Harris AD, Pineles L, Johnson JK, O'Hara LM, Smith LL, French I, et al. Prevalence of Acinetobacter baumannii and Candida auris in Patients Receiving Mechanical Ventilation. JAMA. 2023;330(18):1769-1772. Biswal M, Rudramurthy SM, Jain N, Shamanth AS, Sharma D, Jain K, et al. Controlling a possible outbreak of Candida auris infection: lessons learnt from multiple interventions. J Hosp Infect. 2017;97(4):363-370. de St Maurice A, Parti U, Anikst VE, Harper T, Mirasol R, Dayo AJ, et al. Clinical, microbiological, and genomic characteristics of clade-III Candida auris colonization and infection in southern California, 2019-2022. Infect Control Hosp Epidemiol. 2023;44(7):1093-1101. Southwick K, Ostrowsky B, Greenko J, Adams E, Lutterloh E; NYS C. auris Team; et al. A description of the first Candida auris -colonized individuals in New York State, 2016-2017. Am J Infect Control. 2022;50(3):358-360. Kenters N, Kiernan M, Chowdhary A, Denning DW, Pemán J, Saris K, et al. Control of Candida auris in healthcare institutions: Outcome of an International Society for Antimicrobial Chemotherapy expert meeting. Int J Antimicrob Agents. 2019;54(4):400-406. Rossow J, Ostrowsky B, Adams E, Greenko J, McDonald R, Vallabhaneni S, et al. Factors Associated With Candida auris Colonization and Transmission in Skilled Nursing Facilities With Ventilator Units, New York, 2016-2018. Clin Infect Dis. 2021 Jun 1;72(11):e753-e760. Sayeed MA, Farooqi J, Jabeen K, Awan S, Mahmood SF. Clinical spectrum and factors impacting outcome of Candida auris : a single center study from Pakistan. BMC Infect Dis. 2019;19(1):384. Cortegiani A, Misseri G, Fasciana T, Giammanco A, Giarratano A, Chowdhary A. Epidemiology, clinical characteristics, resistance, and treatment of infections by Candida auris . J Intensive Care. 2018;6:69. Briano F, Magnasco L, Sepulcri C, Dettori S, Dentone C, Mikulska M, et al. Candida auris Candidemia in Critically Ill, Colonized Patients: Cumulative Incidence and Risk Factors. Infect Dis Ther. 2022 Jun;11(3):1149-1160. Hu S, Zhu F, Jiang W, Wang Y, Quan Y, Zhang G, et al. Retrospective Analysis of the Clinical Characteristics of Candida auris Infection Worldwide From 2009 to 2020. Front Microbiol. 2021;12:658329. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 04 May, 2026 Reviews received at journal 05 Apr, 2026 Reviewers agreed at journal 24 Mar, 2026 Reviewers invited by journal 09 Mar, 2026 Editor assigned by journal 20 Feb, 2026 Submission checks completed at journal 12 Feb, 2026 First submitted to journal 11 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8854588","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":604667695,"identity":"e0610c54-9806-4f7d-83c9-17767c3e1b8a","order_by":0,"name":"Reyhan Yiş","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIie3RMUvDQBTA8VcCicPFW19Ia7/ClcJFUSh+E4sQlxSdMorTdYl27eZncKmOkUCno3PGuGRKoZNUsGBOFFpM0tXh/sMbHvfjDg5Ap/ufmT/TmAPEuLPcR0x/l5B9pDzCS7K1rCPeOOLZxwsMH6h8z9by+JqOJYNVmMDAjStJW0qvdy9hKHD03ItSPJnKgLWmiwTI4UUlQQw42kIRe4ZkhYxBwAxblKTmZdgtuLNRhMrc+VSEFszYNBEk3P2+BQLTJWlJsLyl1USIH7odgX2BvtdvS2SY5jev0eKKEFlDrGTmLMVZ53GS5G/F/JbRyeVTtg5Pj6yomgAcMCXP77Y3MTT+pJWpOfiz0el0Ot1vX+srVMCvNihbAAAAAElFTkSuQmCC","orcid":"","institution":"Bakırçay Üniversitesi","correspondingAuthor":true,"prefix":"","firstName":"Reyhan","middleName":"","lastName":"Yiş","suffix":""},{"id":604667696,"identity":"6706da1d-71d8-4c24-b500-fc2272365ec6","order_by":1,"name":"Güneş Şenol","email":"","orcid":"","institution":"Bakırçay Üniversitesi","correspondingAuthor":false,"prefix":"","firstName":"Güneş","middleName":"","lastName":"Şenol","suffix":""}],"badges":[],"createdAt":"2026-02-11 17:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8854588/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8854588/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104780676,"identity":"de43b2a6-236d-4ac3-b73b-d50962a4dd70","added_by":"auto","created_at":"2026-03-17 07:53:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":826176,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8854588/v1/82551fee-b639-4408-9a54-da7eb2151ced.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Candidozyma auris in Intensive Care Units: A Point Prevalence Study and Six-Month Colonization–Infection Surveillance","fulltext":[{"header":"1. BACKGRAUND","content":"\u003cp\u003eInfections caused by Candida species are among the leading causes of morbidity and mortality in critically ill patients. Over the past decade, their incidence has increased progressively, largely due to the growing number of invasive medical procedures, widespread use of broad-spectrum antimicrobial agents, and the rising population of immunosuppressed critically ill patients. Although \u003cem\u003eCandida albicans\u003c/em\u003e remains the most frequently isolated species, the prophylactic and extensive use of antifungal agents has led to a marked epidemiological shift toward non-albicans Candida species with reduced susceptibility or resistance to azoles and echinocandins. In recent years, \u003cem\u003eCandida auris\u003c/em\u003e has emerged as a globally significant nosocomial pathogen. This multidrug-resistant (MDR) yeast exhibits resistance to fluconazole and variable susceptibility to other azoles, amphotericin B, and echinocandins. Due to its ability to cause severe outbreaks and its extensive intrinsic and acquired antifungal resistance, \u003cem\u003eC. auris\u003c/em\u003e is considered a major global public health threat [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Since its first isolation in 2009 from an external ear canal drainage specimen of a patient in Japan, \u003cem\u003eC. auris\u003c/em\u003e has been recognized as a novel fungal pathogen capable of causing deep-seated infections and fungemia, particularly in high-risk populations [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In 2022, the World Health Organization included \u003cem\u003eC. auris\u003c/em\u003e in its list of fungal pathogens of \u0026ldquo;critical priority\u0026rdquo; [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMore recently, based on a genome-scale phylogenetic analysis, \u003cem\u003eCandida auris\u003c/em\u003e and related species have been reclassified into the newly established genus Candidozyma [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. \u003cem\u003eC. auris\u003c/em\u003e is also notable for being the first fungal pathogen designated as an urgent public health threat by the Centers for Disease Control and Prevention (CDC) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Following its detection in patients in the United States in 2016, the CDC issued an alert emphasizing mandatory notification to clinicians, laboratories, and public health authorities upon identification of \u003cem\u003eC. auris\u003c/em\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBeyond antifungal resistance, \u003cem\u003eC. auris\u003c/em\u003e is particularly concerning due to its association with high mortality rates, especially among immunocompromised patients. Unlike other Candida species, \u003cem\u003eC. auris\u003c/em\u003e demonstrates remarkable resistance to commonly used surface disinfectants, possesses a strong biofilm-forming capacity, and exhibits thermotolerance and osmotolerance [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These virulence-enhancing characteristics facilitate its persistence in hospital environments and enable transmission through invasive medical procedures, wounds, or medical devices via breaches in skin or mucosal barriers. \u003cem\u003eC. auris\u003c/em\u003e has the capacity to colonize multiple body sites, including the skin, mucosa, respiratory tract, and bloodstream, and may subsequently cause invasive infections in vulnerable patients. Prolonged colonization of patients\u0026rsquo; skin and mucosa, as well as environmental persistence within healthcare settings, significantly contribute to intra- and inter-facility transmission [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Although colonization is the predominant manifestation, candidemia typically follows colonization and is associated with mortality rates reaching up to 70% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe cornerstone of prevention and control of \u003cem\u003eC. auris\u003c/em\u003e infections includes rapid identification of colonized patients, strict adherence to contact precautions, and effective environmental cleaning [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The CDC recommends screening high-risk patients for \u003cem\u003eC. auris\u003c/em\u003e colonization using composite swab samples obtained from the bilateral axilla and groin regions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Patients with epidemiological links to confirmed cases, prior healthcare exposure, current hospitalization, or known risk factors for colonization are considered high-risk populations. Consequently, screening for \u003cem\u003eC. auris\u003c/em\u003e is strongly recommended for patients hospitalized in intensive care units (ICUs), who are inherently at increased risk for candidiasis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In T\u0026uuml;rkiye, the Ministry of Health General Directorate of Public Health has similarly recommended active screening strategies in healthcare institutions to identify patients colonized with \u003cem\u003eC. auris\u003c/em\u003e [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly identification of colonized or infected individuals is critical for guiding isolation measures and implementing infection control interventions, including disinfection of the patient\u0026rsquo;s immediate environment, to prevent further transmission. Following the detection of \u003cem\u003eC. auris\u003c/em\u003e growth in a urine culture obtained from a patient in the Coronary ICU of our hospital in February 2025, the Infection Control Committee initiated a point prevalence study to assess the extent of \u003cem\u003eC. auris\u003c/em\u003e colonization within the institution. Composite swab samples were collected from ICU patients to determine colonization rates.\u003c/p\u003e"},{"header":"2. OBJECTIVES","content":"\u003cp\u003eThe present study aimed to evaluate \u003cem\u003eC. auris\u003c/em\u003e colonization rates through point prevalence screening in the ICUs of our hospital, to assess colonization and infection outcomes during a subsequent six-month follow-up period, and to establish a diagnostic algorithm for \u003cem\u003eC. auris\u003c/em\u003e identification in our laboratory.\u003c/p\u003e"},{"header":"3. METHODS","content":"\u003cp\u003e\u003cstrong\u003e3.1. Study Design and Patient Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study comprised a cross-sectional point prevalence survey conducted in the intensive care units (ICUs) of a tertiary-care hospital, followed by a six-month observational surveillance period. After the detection of \u003cem\u003eC. auris\u003c/em\u003e growth in a urine culture obtained from a patient hospitalized in the Coronary ICU in February 2025, the hospital Infection Control Committee decided to perform a point prevalence study to assess the extent of \u003cem\u003eC. auris\u003c/em\u003e colonization across all ICUs.\u003c/p\u003e\n\u003cp\u003eAll patients hospitalized in the ICUs on the day of the point prevalence survey were included in the study. Accordingly, a total of 70 patients hospitalized in the following units were evaluated: Anesthesia ICU (AICU; n = 10), Internal Medicine ICU (IMICU; n = 9), General ICU-1 (GICU-1; n = 8), General ICU-2 (GICU-2; n = 12), General ICU-3 (GICU-3; n = 9), Chest Diseases ICU (n = 7), Cardiovascular Surgery ICU (n = 1), Coronary ICU (n = 8), and Neurology ICU (n = 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. Sampling and Screening Strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs part of the point prevalence study, composite swab samples were obtained on the same day from all patients by swabbing the bilateral axilla and groin areas. In addition, urine cultures were collected from patients with indwelling urinary catheters via Foley catheter sampling, and wound swab specimens were obtained from patients with open wounds.\u003c/p\u003e\n\u003cp\u003eIn total, 157 clinical specimens were submitted to the Microbiology Laboratory, including 70 composite screening swabs, 69 urine samples, and 18 wound swab specimens.\u003c/p\u003e\n\u003cp\u003eFollowing the point prevalence study, routine colonization screening and blood culture results were monitored for a period of six months in patients hospitalized in the ICUs. During this follow-up period, composite swab samples were collected from newly admitted ICU patients to assess \u003cem\u003eC. auris\u003c/em\u003e colonization status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3. Culture and Identification Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eScreening for \u003cem\u003eC. auris\u003c/em\u003e was performed using CHROMagar\u0026trade; Candida Plus (CHROMagar, France), a chromogenic medium on which \u003cem\u003eC. auris\u003c/em\u003e produces light blue colonies with a characteristic blue halo, allowing differentiation from other related and unrelated yeast species.\u003c/p\u003e\n\u003cp\u003eComposite screening swabs were inoculated onto CHROMagar\u0026trade; Candida Plus and sheep blood agar plates and incubated at 35 \u0026deg;C for 24\u0026ndash;48 hours. Urine and wound swab specimens were cultured on sheep blood agar and eosin methylene blue (EMB) agar media.\u003c/p\u003e\n\u003cp\u003eAll yeast-like colonies were initially evaluated using the germ tube test. Germ tube\u0026ndash;negative isolates were further examined morphologically on cornmeal Tween 80 agar. Definitive identification of suspected isolates was performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4. Assessment of Infection and Risk Factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the six-month surveillance period, patients with \u003cem\u003eC. auris\u003c/em\u003e growth detected in blood cultures were classified as infection cases. In these patients, known risk factors\u0026mdash;including broad-spectrum antibiotic use, presence of central venous catheters, mechanical ventilation, immunosuppression, history of surgical procedures, and other relevant clinical factors\u0026mdash;were evaluated retrospectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5. Statistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were expressed as numbers (n) and percentages (%). Comparisons between groups were performed using the chi-square test or Fisher\u0026rsquo;s exact test for categorical variables, as appropriate. Differences in \u003cem\u003eC. auris\u003c/em\u003e isolation rates according to specimen type were analyzed using the chi-square test. The association between colonization and subsequent infection was evaluated using odds ratios (ORs) with 95% confidence intervals (CIs). A p value of \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.6. Ethical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Izmir Bakircay University Clinical Research Ethics Committee (Approval No: 2732, Date: 28.01.2026). As this study was conducted retrospectively and involved no direct patient intervention, informed consent was waived by the ethics committee.\u003c/p\u003e"},{"header":"4.\tRESULTS","content":"\u003cp\u003e\u003cstrong\u003e4.1. Point Prevalence Survey Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComposite screening swab samples obtained from a total of 70 ICU patients revealed \u003cem\u003eCandidozyma auris\u003c/em\u003e growth in 7 patients, corresponding to a colonization prevalence of 10.0%. During the same period, \u003cem\u003eC. auris\u003c/em\u003e was isolated from 1 of 69 urine culture specimens and from 2 of 18 wound swab specimens (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Distribution of screened patients and Candidozyma auris growth according to intensive care unit and specimen type\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"585\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of Patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScreening Swabs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrine Cultures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWound Cultures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eC. auris\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;in Screening\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eC. auris\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;in Urine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eC. auris\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;in Wound\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnesthesia ICU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInternal Medicine ICU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGeneral ICU-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGeneral ICU-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGeneral ICU-3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChest Diseases ICU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiovascular Surgery ICU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoronary ICU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeurology ICU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAmong the seven patients with \u003cem\u003eC. auris\u003c/em\u003e detected in composite screening swabs, five showed growth exclusively in the screening swab samples. One patient had \u003cem\u003eC. auris\u003c/em\u003e growth in both the composite swab and wound culture, while another patient demonstrated growth in all three specimen types (composite swab, urine culture, and wound swab) (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2. \u003cem\u003eCandidozyma auris\u003c/em\u003e positivity rates according to specimen type\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eSpecimen Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePositive / Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePositivity (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eScreening swabs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e7 / 70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eUrine cultures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1 / 69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eWound cultures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e2 / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e10 / 157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e6.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFive of the colonized patients were hospitalized in the Anesthesia ICU, one in General ICU-1, and one in General ICU-2. The highest colonization rate was observed in the Anesthesia ICU, where 5 of 10 patients (50%) were colonized. Colonization rates differed significantly among the ICUs (p = 0.0044).\u003c/p\u003e\n\u003cp\u003eThe positivity rates according to specimen type were 7/70 (10.0%) for composite screening swabs, 1/69 (1.4%) for urine cultures, and 2/18 (11.1%) for wound swab specimens. Although isolation rates varied among specimen types, the difference was not statistically significant (p = 0.0773). When all specimen types were evaluated collectively, the overall positivity rate was 6.37% (10/157).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2. Six-Month Colonization Surveillance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the six-month follow-up period after the point prevalence survey, \u003cem\u003eC. auris\u003c/em\u003e colonization was detected in screening cultures from 15 patients. These patients were hospitalized in the following ICUs: Anesthesia ICU (n = 6), General ICU-1 (n = 2), General ICU-2 (n = 4), General ICU-3 (n = 2), and Chest Diseases ICU (n = 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3. Infection Rates and Clinical Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the same six-month surveillance period, \u003cem\u003eC. auris\u003c/em\u003e was isolated from blood cultures of nine patients: General ICU-1 (n = 1), Anesthesia ICU (n = 2), General ICU-2 (n = 3), and General ICU-3 (n = 3). Among these nine patients, three had previously been identified as colonized.\u003c/p\u003e\n\u003cp\u003eThe risk of developing bloodstream infection was approximately 4.5-fold higher in colonized patients (3/7) compared with non-colonized patients (6/63) (odds ratio [OR] = 4.5; Fisher\u0026rsquo;s exact test, p = 0.045).\u003c/p\u003e\n\u003cp\u003eThe interval between detection of colonization and blood culture positivity was one day in one patient, nine days in another patient, and approximately two months in the third patient.\u003c/p\u003e\n\u003cp\u003eIn two of the nine patients with \u003cem\u003eC. auris\u003c/em\u003e fungemia, recurrent bloodstream infection was observed despite antifungal therapy (amphotericin B in one patient and an echinocandin in the other). Recurrent episodes occurred 13 and 30 days after the initial isolation, respectively. All patients with positive blood cultures experienced fatal outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4. Risk Factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most frequently identified risk factors among patients who developed \u003cem\u003eC. auris\u003c/em\u003e fungemia were broad-spectrum antibiotic use (100%), prolonged ICU stay (100%), presence of urinary catheters (100%), and use of central venous catheters (88.9%). Mechanical ventilation was present in 55.6% of patients, and 66.7% had a history of parenteral nutrition. All patients were older than 65 years (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Clinical characteristics and risk factors of patients with \u003cem\u003eCandidozyma auris\u003c/em\u003e fungemia (n = 9)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eRisk Factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eBroad-spectrum antibiotic use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eProlonged ICU stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eUrinary catheter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eCentral venous catheter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e88.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eMechanical ventilation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e55.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eParenteral nutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eSurgical procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eBlood transfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eImmunosuppression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eSteroid use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"5.\tDISCUSSION","content":"\u003cp\u003eThis study presents the results of a point prevalence survey and a subsequent six-month observational surveillance conducted to evaluate the frequency of \u003cem\u003eC. auris\u003c/em\u003e colonization and infection in the intensive care units of a tertiary-care hospital. Following the first identification of \u003cem\u003eC. auris\u003c/em\u003e in our institution, this investigation provides valuable insight into the immediate colonization burden and short-term clinical outcomes associated with this emerging pathogen.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eC. auris\u003c/em\u003e is a recently emerged, multidrug-resistant yeast that has caused large-scale outbreaks in numerous countries worldwide and is now recognized as part of a complex of multidrug-resistant fungal pathogens [14]. One of the major challenges associated with \u003cem\u003eC. auris\u003c/em\u003e is the difficulty of accurate identification using conventional microbiological methods. Misidentification has frequently been reported with species such as \u003cem\u003eC. haemulonii\u003c/em\u003e, \u003cem\u003eC. famata\u003c/em\u003e, \u003cem\u003eC. sake\u003c/em\u003e, \u003cem\u003eC. catenulata\u003c/em\u003e, \u003cem\u003eRhodotorula glutinis\u003c/em\u003e, and \u003cem\u003eSaccharomyces cerevisiae\u0026nbsp;\u003c/em\u003e[15]. Currently, advanced molecular techniques, including PCR-based methods and DNA sequencing, as well as MALDI-TOF mass spectrometry, are considered the gold standard for accurate identification of \u003cem\u003eC. auris\u003c/em\u003e. MALDI-TOF MS, in particular, has demonstrated high accuracy and rapid turnaround time by detecting \u003cem\u003eCandida\u003c/em\u003e ribosomal proteins and comparing them with reference spectra in established databases [15, 16]. In the present study, although the development of a cost-effective diagnostic algorithm incorporating conventional methods was initially considered, definitive identification was achieved using MALDI-TOF MS due to the lack of specific discriminatory features in traditional approaches. Given that MALDI-TOF MS is not universally available in all healthcare institutions, improving and validating conventional diagnostic strategies remains an important priority, especially for resource-limited settings.\u003c/p\u003e\n\u003cp\u003eAccurate and timely identification of \u003cem\u003eC. auris\u003c/em\u003e is essential for the initiation of appropriate antifungal therapy and the implementation of infection prevention and control measures. These interventions are particularly critical in limiting and controlling potential hospital outbreaks caused by a pathogen characterized by high mortality rates and limited therapeutic options. The present study contributes to this effort by evaluating screening results aimed at identifying patients colonized or infected with \u003cem\u003eC. auris\u003c/em\u003e and assessing the effectiveness of infection control strategies.\u003c/p\u003e\n\u003cp\u003eGuidelines for the management of \u003cem\u003eC. auris\u003c/em\u003e colonization and infection have been published by the CDC, the European Centre for Disease Prevention and Control (ECDC), and the Turkish Ministry of Health [13, 17, 18]. Because \u003cem\u003eC. auris\u003c/em\u003e is transmitted through close contact with colonized individuals or contaminated environments, screening is recommended for patients with recent healthcare exposure or epidemiological links to confirmed cases. Following the identification of the index case in the Coronary ICU of our hospital, a same-day cross-sectional screening of all ICU patients was performed to determine the institutional colonization burden.\u003c/p\u003e\n\u003cp\u003eIn this point prevalence survey, \u003cem\u003eC. auris\u003c/em\u003e colonization was detected in 7 of 70 patients (10%). Additionally, \u003cem\u003eC. auris\u003c/em\u003e was isolated from urine culture in one patient and from wound cultures in two patients. Among colonized patients, five had positive composite screening swabs only, while growth was detected in multiple specimen types in two patients. When compared with point prevalence studies conducted in other countries, the colonization rate observed in our study appears relatively high. Malik et al. [19] reported a colonization rate of 1.6% in a study involving 430 patients in the United States, whereas Harris et al. [20] identified a colonization rate of 6.6% in another U.S.-based point prevalence survey. In contrast, our colonization rate of 10% suggests a substantial colonization burden in ICU settings.\u003c/p\u003e\n\u003cp\u003eColonization rates reported from different regions vary widely. Studies from India have reported colonization rates as high as 21% among patients exposed to index cases, while St. Maurice et al. and Southwick et al. reported rates of 4.5% and 7%, respectively [21- 23]. Variations in colonization rates may be attributed to differences in patient populations, duration of ICU stay, intensity of invasive procedures, effectiveness of infection control practices, and screening strategies. The relatively high colonization rate observed in our study underscores the ability of \u003cem\u003eC. auris\u003c/em\u003e to spread rapidly in ICU environments characterized by prolonged hospitalization and frequent invasive interventions.\u003c/p\u003e\n\u003cp\u003eThe isolate obtained from a urine culture in February 2025, which represented the first detection of \u003cem\u003eC. auris\u003c/em\u003e in our institution, was designated as the index case. As this isolate originated from the Coronary ICU, the Infection Control Committee decided to include all ICUs in the point prevalence survey and subsequent screening program. Following the initial survey, routine screening of all newly admitted ICU patients using composite swab samples was implemented. Due to the variable duration of colonization, repeat screening was not performed for patients who tested positive, and routine screening has continued as planned.\u003c/p\u003e\n\u003cp\u003eIn addition to standard precautions, contact precautions are required for patients colonized or infected with \u003cem\u003eC. auris\u0026nbsp;\u003c/em\u003e[17,18]. Because transmission can occur via medical devices, these measures include the use of gloves and long-sleeved gowns, as well as patient-dedicated or single-use non-critical equipment. Placement of patients in single rooms is preferred; when not feasible, cohorting of patients with \u003cem\u003eC. auris\u003c/em\u003e colonization or infection may be considered. In situations of limited staffing, cohorting of both patients and healthcare personnel may also be necessary [9, 24]. Accurate identification of colonized or infected patients is a prerequisite for the successful implementation of these measures.\u003c/p\u003e\n\u003cp\u003eColonization with \u003cem\u003eC. auris\u003c/em\u003e may develop within hours or days after exposure and can persist for months without causing symptoms. Nevertheless, colonization places patients at risk for invasive infection, with approximately 5\u0026ndash;10% of known colonized individuals developing invasive disease [25]. Invasive \u003cem\u003eC. auris\u003c/em\u003e infections may occur days to months after colonization, particularly in patients with immunosuppression, significant comorbidities, indwelling central venous or urinary catheters, prior healthcare exposure, and recent antimicrobial therapy. Reported clinical manifestations include candidemia, catheter-related infections, soft tissue or wound infections, osteomyelitis, myocarditis, meningitis, and urinary tract infections [26, 27]. Nearly one-quarter of colonized ICU patients are reported to be at risk for developing \u003cem\u003eC. auris\u003c/em\u003e bloodstream infections [28].\u003c/p\u003e\n\u003cp\u003eDuring the six-month follow-up period in our study, \u003cem\u003eC. auris\u003c/em\u003e colonization was detected in 15 patients, indicating ongoing transmission and persistence within the ICU environment. Colonized patients were most frequently identified in the Anesthesia ICU and General ICUs, a finding that may be related to higher patient turnover, increased use of invasive devices, and more frequent administration of broad-spectrum antimicrobials in these units. The resistance of \u003cem\u003eC. auris\u003c/em\u003e to disinfectants and its ability to survive on environmental surfaces for prolonged periods further contribute to its role as a persistent reservoir in ICU settings. The rapid emergence of multiple colonized patients following a single index case highlights this transmission potential.\u003c/p\u003e\n\u003cp\u003eDuring the same six-month period, \u003cem\u003eC. auris\u003c/em\u003e was isolated from blood cultures of nine patients, three of whom had previously been identified as colonized. The interval between colonization detection and bloodstream infection ranged from one day to two months. In two patients, recurrent fungemia occurred despite antifungal therapy with amphotericin B or echinocandins, suggesting that variable antifungal susceptibility and biofilm formation may adversely affect treatment outcomes. These findings emphasize the importance of antifungal susceptibility testing and, when feasible, investigation of molecular resistance mechanisms. The retrospective analysis of 912 patients with \u003cem\u003eC. auris\u003c/em\u003e infections reported between 2009 and 2020 highlighted that male patients, premature infants, and elderly individuals were disproportionately affected. Consistent with previous studies, underlying comorbidities such as diabetes mellitus, renal disease, trauma, and otologic disorders were frequently observed. More than half of the patients had a history of central venous catheterization and broad-spectrum antibiotic exposure, supporting the notion that invasive procedures and antimicrobial pressure play a pivotal role in the pathogenesis of \u003cem\u003eC. auris\u003c/em\u003e infections. Importantly, renal disease emerged as a significant risk factor for mortality, underscoring the need for careful monitoring and tailored management in this subgroup [29].\u003c/p\u003e\n\u003cp\u003eIn our institution, all patients with \u003cem\u003eC. auris\u003c/em\u003e growth in blood cultures shared similar risk factors, including broad-spectrum antibiotic use, prolonged intensive care unit stay, and urinary catheterization. The presence of hypertension in five patients and diabetes mellitus in four patients further reflects the burden of chronic comorbidities in this population. Interestingly, all patients were older than 65 years, and no statistically significant difference was observed between genders (5 female, 4 male), suggesting that advanced age rather than sex may be a more critical determinant of susceptibility.\u003c/p\u003e\n\u003cp\u003eIn our cohort, all patients with \u003cem\u003eC. auris\u003c/em\u003e fungemia died, reflecting the severe clinical course associated with invasive \u003cem\u003eC. auris\u003c/em\u003e infections in critically ill patients. However, it should be considered that mortality may not be solely attributable to \u003cem\u003eC. auris\u003c/em\u003e infection but may also be influenced by advanced age, prolonged ICU stay, extensive comorbidities, broad-spectrum antibiotic exposure, and the presence of invasive devices. In our study population, all patients were older than 65 years and exhibited multiple risk factors known to be associated with increased mortality.\u003c/p\u003e\n\u003cp\u003eAn important strength of this study is the implementation of a diagnostic algorithm that integrates chromogenic media, conventional microbiological methods, and MALDI-TOF MS for \u003cem\u003eC. auris\u003c/em\u003e identification. Given the high risk of misidentification using traditional techniques, the rapid and accurate identification provided by MALDI-TOF MS likely contributed to the timely initiation of infection control measures. Nevertheless, the limited availability of this technology highlights the need for the development of reliable and cost-effective screening algorithms suitable for broader implementation.\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. The relatively short duration of follow-up and the limited number of patients reduce the generalizability of the findings. Longer-term and larger-scale studies are needed to better define risk factors and transmission dynamics. In addition, antifungal susceptibility testing and molecular epidemiological analyses were not included, precluding assessment of clonal relatedness among isolates. Despite these limitations, the study provides important evidence of \u003cem\u003eC. auris\u003c/em\u003e presence within our institution and supports the strengthening of infection control strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.1. Conclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn conclusion, \u003cem\u003eC. auris\u003c/em\u003e colonization was detected at a rate of 10% in the point prevalence survey conducted in the intensive care units of our hospital, with a significantly higher prevalence observed in the Anesthesia ICU compared with other units. Colonized patients demonstrated a markedly increased risk of developing invasive infection. Among patients who developed infection, risk factors such as broad-spectrum antibiotic use, prolonged ICU stay, and the presence of invasive devices were highly prevalent.\u003c/p\u003e\n\u003cp\u003eThis study represents the first assessment of institutional exposure to \u003cem\u003eC. auris\u003c/em\u003e in our hospital through a point prevalence approach. Colonization surveillance and infection outcomes during the subsequent six-month period were also evaluated. In parallel, a practical diagnostic algorithm for \u003cem\u003eC. auris\u003c/em\u003e identification was assessed and implemented in our laboratory. The experience gained during this process highlights the critical importance of rapid microbiological diagnosis and the timely application of infection control measures.\u003c/p\u003e\n\u003cp\u003eOverall, \u003cem\u003eC. auris\u003c/em\u003e is a major nosocomial pathogen capable of rapid dissemination in intensive care units and of causing invasive infections associated with high mortality following colonization. Early identification, active screening strategies, and strict infection prevention and control measures play a pivotal role in limiting transmission. Future prospective studies involving larger patient populations and longer follow-up periods are needed to further clarify the clinical impact of \u003cem\u003eC. auris\u003c/em\u003e colonization and infection.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy concept and design: RY, GŞ\u003c/p\u003e\n\u003cp\u003eAcquisition of data: RY\u003c/p\u003e\n\u003cp\u003eAnalysis and interpretation of data: RY\u003c/p\u003e\n\u003cp\u003eDrafting of the manuscript: RY\u003c/p\u003e\n\u003cp\u003eCritical revision of the manuscript for important intellectual content: RY, GŞ\u003c/p\u003e\n\u003cp\u003eStatistical analysis: RY\u003c/p\u003e\n\u003cp\u003eAdministrative, technical, and material support: RY, GŞ\u003c/p\u003e\n\u003cp\u003eStudy supervision: RY, GŞ\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the local Ethics Committee (approval number: 2732, date: 28/01/2026).\u003cbr\u003e\u0026nbsp;Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare that this study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eJenks J, Tobin EH, Zahra F. \u003cem\u003eCandida auris\u003c/em\u003e. [Updated 2025 Nov 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563297/\u003c/li\u003e\n \u003cli\u003eSatoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. \u003cem\u003eCandida auris\u003c/em\u003e sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol. 2009;53(1):41-4.\u003c/li\u003e\n \u003cli\u003eMeis JF, Chowdhary A. \u003cem\u003eCandida auris\u003c/em\u003e: a global fungal public health threat. Lancet Infect Dis. 2018;18(12):1298-1299.\u003c/li\u003e\n \u003cli\u003eWHO fungal priority pathogens list to guide research, development and public health action. https://iris.who.int/server/api/core/bitstreams/69af4379-4f27-4ac4-8973-74d7b52af7bd/content\u003c/li\u003e\n \u003cli\u003eLiu F, Hu ZD, Zhao XM, Zhao WN, Feng ZX, Yurkov A, et al. Phylogenomic analysis of the \u003cem\u003eCandida auris- Candida haemuli\u003c/em\u003e clade and related taxa in the \u003cem\u003eMetschnikowiaceae,\u003c/em\u003e and proposal of thirteen new genera, fifty-five new combinations and nine new species. Persoonia. 2024;52:22-43.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHarris E. CDC: Candida auris Fungal Infections and Drug Resistance on the Rise. JAMA. 2023 Apr 18;329(15):1248.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eEgger NB, Kainz K, Schulze A, Bauer MA, Madeo F, Carmona-Gutierrez D. The rise of \u003cem\u003eCandida auris\u003c/em\u003e: from unique traits to co-infection potential. Microb Cell. 2022 Aug 1;9(8):141-144.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePiedrahita CT, Cadnum JL, Jencson AL, Shaikh AA, Ghannoum MA, Donskey CJ. Environmental Surfaces in Healthcare Facilities are a Potential Source for Transmission of\u0026nbsp;\u003cem\u003eCandida auris\u003c/em\u003e and Other Candida Species. Infect Control Hosp Epidemiol. 2017 Sep;38(9):1107-1109.\u003c/li\u003e\n \u003cli\u003eAhmad S, Alfouzan W. \u003cem\u003eCandida auris\u003c/em\u003e: Epidemiology, Diagnosis, Pathogenesis, Antifungal Susceptibility, and Infection Control Measures to Combat the Spread of Infections in Healthcare Facilities. Microorganisms. 2021;9(4):807.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKramer DG, da Silva MJ, de Sousa AM, Junior GB, Luiz Filho A.\u0026nbsp;\u003cem\u003eCandida auris\u003c/em\u003e: a literature\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCenters for Disease Control and Prevention. Screening Recommendations for Healthcare Facilities, 2025 [accessed December. 15, 2025]. Available at\u0026nbsp;https://www.cdc.gov/candida-auris/hcp/screening-hcp/index.html\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSarma S, Upadhyay S. Current perspective on emergence, diagnosis and drug resistance in \u003cem\u003eCandida auris\u003c/em\u003e. Infect Drug Resist. 2017;10:155-165.\u003c/li\u003e\n \u003cli\u003eT. C. Sağlık Bakanlığı, Halk Sağlığı Genel M\u0026uuml;d\u0026uuml;rl\u0026uuml;ğ\u0026uuml;. \u0026nbsp;Sağlık Hizmetlerinde\u0026nbsp;\u003cem\u003eC. auris\u003c/em\u003e. 2025. Available at https://hsgm.saglik.gov.tr/media/attachments/2025/05/14/saGlik-hIzmetlerInde-c.auris.pdf\u003c/li\u003e\n \u003cli\u003eRuiz-Gait\u0026aacute;n A, Moret AM, Tasias-Pitarch M, Aleixandre-L\u0026oacute;pez AI, Mart\u0026iacute;nez-Morel H, Calabuig E, et al. An outbreak due to\u0026nbsp;\u003cem\u003eCandida auris\u003c/em\u003e with prolonged colonisation and candidaemia in a tertiary care European hospital. Mycoses. 2018 Jul;61(7):498-505.\u003c/li\u003e\n \u003cli\u003e15\u0026nbsp;Long B, Lacy AJ, Koyfman A, Liang SY. \u003cem\u003eCandida auris\u003c/em\u003e: A focused review for emergency clinicians. Am J Emerg Med. 2024;84:162-167.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDennis EK, Chaturvedi S, Chaturvedi V. So Many Diagnostic Tests, So Little Time: Review and Preview of \u003cem\u003eCandida auris\u003c/em\u003e Testing in Clinical and Public Health Laboratories. Front Microbiol. 2021;12:757835.\u003c/li\u003e\n \u003cli\u003eCenters for Disease Control and Prevention. Infection control guidance: \u003cem\u003eCandida auris\u003c/em\u003e. 2024. [Accessed June 14, 2024].\u0026nbsp;Available at https://www.cdc.gov/candida-auris/hcp/infection-control/index.html.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eEuropean Centre for Disease Prevention and Control Candida auris in Healthcare Settings-Europe. [Accessed April 23, 2018]. ECDC, Stockholm. Available at https://www.ecdc.europa.eu/sites/default/files/documents/RRA-Candida-auris-European-Union-countries.pdf \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMalik A, Shallal A, Ruby A, Malm J, Mclenon J, Shanahan C, et al. P-361. Outcome of \u003cem\u003eCandida auris\u003c/em\u003e Point Prevalence Survey in a Tertiary Care Hospital in Southeast Michigan. Open Forum Infect Dis. 2025;12(Suppl 1):ofae631.562.\u003c/li\u003e\n \u003cli\u003eHarris AD, Pineles L, Johnson JK, O\u0026apos;Hara LM, Smith LL, French I, et al. Prevalence of \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e and \u003cem\u003eCandida auris\u003c/em\u003e in Patients Receiving Mechanical Ventilation. JAMA. 2023;330(18):1769-1772.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBiswal M, Rudramurthy SM, Jain N, Shamanth AS, Sharma D, Jain K, et al. Controlling a possible outbreak of Candida auris infection: lessons learnt from multiple interventions. J Hosp Infect. 2017;97(4):363-370.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ede St Maurice A, Parti U, Anikst VE, Harper T, Mirasol R, Dayo AJ, et al. Clinical, microbiological, and genomic characteristics of clade-III \u003cem\u003eCandida auris\u003c/em\u003e colonization and infection in southern California, 2019-2022. Infect Control Hosp Epidemiol. 2023;44(7):1093-1101.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSouthwick K, Ostrowsky B, Greenko J, Adams E, Lutterloh E; NYS \u003cem\u003eC. auris\u003c/em\u003e Team; et al. A description of the first \u003cem\u003eCandida auris\u003c/em\u003e-colonized individuals in New York State, 2016-2017. Am J Infect Control. 2022;50(3):358-360.\u003c/li\u003e\n \u003cli\u003eKenters N, Kiernan M, Chowdhary A, Denning DW, Pem\u0026aacute;n J, Saris K, et al. Control of \u003cem\u003eCandida auris\u003c/em\u003e in healthcare institutions: Outcome of an International Society for Antimicrobial Chemotherapy expert meeting. Int J Antimicrob Agents. 2019;54(4):400-406.\u003c/li\u003e\n \u003cli\u003eRossow J, Ostrowsky B, Adams E, Greenko J, McDonald R, Vallabhaneni S, et al. Factors Associated With \u003cem\u003eCandida auris\u003c/em\u003e Colonization and Transmission in Skilled Nursing Facilities With Ventilator Units, New York, 2016-2018. Clin Infect Dis. 2021 Jun 1;72(11):e753-e760.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSayeed MA, Farooqi J, Jabeen K, Awan S, Mahmood SF. Clinical spectrum and factors impacting outcome of \u003cem\u003eCandida auris\u003c/em\u003e: a single center study from Pakistan. BMC Infect Dis. 2019;19(1):384.\u003c/li\u003e\n \u003cli\u003eCortegiani A, Misseri G, Fasciana T, Giammanco A, Giarratano A, Chowdhary A. Epidemiology, clinical characteristics, resistance, and treatment of infections by \u003cem\u003eCandida auris\u003c/em\u003e. J Intensive Care. 2018;6:69.\u003c/li\u003e\n \u003cli\u003eBriano F, Magnasco L, Sepulcri C, Dettori S, Dentone C, Mikulska M, et al. \u003cem\u003eCandida auris\u003c/em\u003e Candidemia in Critically Ill, Colonized Patients: Cumulative Incidence and Risk Factors. Infect Dis Ther. 2022 Jun;11(3):1149-1160.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHu S, Zhu F, Jiang W, Wang Y, Quan Y, Zhang G, et al. Retrospective Analysis of the Clinical Characteristics of \u003cem\u003eCandida auris\u003c/em\u003e Infection Worldwide From 2009 to 2020. Front Microbiol. 2021;12:658329. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"intm","sideBox":"Learn more about [International Microbiology](https://www.springer.com/journal/10123)","snPcode":"10123","submissionUrl":"https://submission.nature.com/new-submission/10123/3","title":"International Microbiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Candidozyma auris, Candida auris, Intensive Care Units, Colonization, Bloodstream Infection, Infection Control","lastPublishedDoi":"10.21203/rs.3.rs-8854588/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8854588/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCandidozyma auris\u003c/em\u003e has emerged as a globally significant nosocomial pathogen due to its multidrug antifungal resistance, environmental persistence, and high mortality rates. This study aimed to determine the prevalence of \u003cem\u003eC. auris\u003c/em\u003e colonization through a point prevalence screening in the intensive care units (ICUs) of our hospital and to evaluate colonization and infection outcomes during a subsequent six-month follow-up period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study aimed to evaluate \u003cem\u003eC. auris\u003c/em\u003e colonization rates through point prevalence screening in the ICUs of our hospital, to assess colonization and infection outcomes during a subsequent six-month follow-up period, and to establish a diagnostic algorithm for \u003cem\u003eC. auris\u003c/em\u003e identification in our laboratory.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing the detection of an index \u003cem\u003eC. auris \u003c/em\u003ecase in our hospital in February 2025, a point prevalence study was conducted in all ICUs. Composite swab samples (bilateral axilla and groin) were obtained from hospitalized patients on the same day. In addition, urine and wound cultures were collected from eligible patients. Isolates were identified using chromogenic media, conventional microbiological methods, and MALDI-TOF MS. After the point prevalence study, surveillance for colonization and bloodstream infection was performed over a six-month period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eC. auris\u003c/em\u003e colonization was detected in 7 of 70 ICU patients (10%) based on composite swab samples. During the six-month follow-up, colonization was identified in 15 patients, and \u003cem\u003eC. auris\u003c/em\u003e fungemia developed in nine patients. All patients with positive blood cultures died. The most frequently identified risk factors were broad-spectrum antibiotic use, prolonged ICU stay, and the presence of urinary catheters.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur findings demonstrate that \u003cem\u003eC. auris\u003c/em\u003e colonization can be detected at a high rate in intensive care units and that severe invasive infections may develop following colonization. Early diagnosis, active screening strategies, and effective infection control measures are critical for reducing \u003cem\u003eC. auris\u003c/em\u003e-associated morbidity and mortality.\u003c/p\u003e","manuscriptTitle":"Candidozyma auris in Intensive Care Units: A Point Prevalence Study and Six-Month Colonization–Infection Surveillance","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-12 04:21:25","doi":"10.21203/rs.3.rs-8854588/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-04T15:30:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-05T10:57:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42456308245819225594455572551863099760","date":"2026-03-24T07:25:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-09T13:19:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-20T13:40:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-13T04:47:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Microbiology","date":"2026-02-11T17:36:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"intm","sideBox":"Learn more about [International Microbiology](https://www.springer.com/journal/10123)","snPcode":"10123","submissionUrl":"https://submission.nature.com/new-submission/10123/3","title":"International Microbiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"8a259f5a-b8e6-4797-a127-adf1317dc376","owner":[],"postedDate":"March 12th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-04T15:30:56+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T09:40:28+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-12 04:21:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8854588","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8854588","identity":"rs-8854588","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}