Fernando González Candelas
Professor of Genetics at the University of Valencia and researcher at the mixed unit Infection and Public Health FISABIO/Universitat de Valencia
The ECDC report is based on data submitted by national epidemiological surveillance systems, and, as stated in the report, this data is not as complete as desired, so it is very likely that the true extent of the problem with infections caused by this fungus is much greater. The report analyzes the trend in diagnosed cases over an 11-year period (2013-2023), confirming a worrying increase, especially in the last four years. This may be due, although not necessarily exclusively, to a real increase in fungal infections and to improvements in diagnostic and surveillance systems.
As in the previous report from 2022, it highlights the high concentration of cases in a few countries, with Spain being one of the most affected. The data collected is aggregated, so it is not possible to analyze in detail the reasons for these increases. In Spain, most of these cases come from a couple of hospitals in the Valencian Community, where the first outbreaks of C. auris were detected in 2016. These nosocomial outbreaks continue to produce cases, although with a lower incidence than a few years ago. In other hospitals, after the initial detection, the spread of the fungus was controlled, and this is where the greatest effort should be focused: early detection of potential cases and the implementation of prevention and control measures that prevent, or at least limit, the spread of the pathogen.
Finally, it emphasizes the need to implement adequate surveillance systems for this pathogen, which can cause very serious infections in hospitalised patients. The lack of these systems prevents us from knowing the real situation, adopting effective preventive measures, and acting in a coordinated manner at the regional, national, and European levels. For example, the report does not include information on the possible intra- and international links of the lineages causing the initial outbreaks, which is essential to understanding the dynamics of the pathogen's spread, as we saw with the first waves of SARS-CoV-2. We know, for example, that the outbreaks in Italy and Spain, two of the countries with the highest prevalence of C. auris infections, have different origins. It would be useful to have genomic data from other countries to better understand, and potentially control, the different pathways through which the fungus enters, establishes itself, and spreads in each country.