Candida auris infections in Spain are the highest in Europe over the last decade, according to an ECDC report

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.

This latest survey (the fourth of its kind) shows the status, as of June 7, 2024, of the yeast Candidozyma auris (formerly Candida auris). This relatively recent pathogen (first described in 2009 in a Japanese patient) has caused numerous outbreaks in hospitals around the world, outbreaks that are very difficult to eradicate. The main concern regarding this pathogen is that it causes candidemia (bloodstream infection), is resistant to antifungal drugs, and tends to spread in intensive care units, where patients are often critically ill.

This survey, conducted in countries of the European Economic Area, three Balkan countries, and Turkey, confirms that the microorganism continues to spread and that cases are still increasing. Three countries report new cases (France, Germany, and Cyprus), while in other countries it is no longer possible to distinguish a specific outbreak from an already endemic situation (Spain, Italy, Romania, and Greece). This data is very important for understanding the epidemiological situation of this pathogen, which spreads very rapidly.  However, the study notes that this is likely only the tip of the iceberg, as many hospitals still do not actively screen for colonized patients (those without an active infection). It is essential to continue raising awareness about the importance of establishing national epidemiological surveillance systems and infection control measures to curb the spread of this pathogen.

This report by the European Centre for Disease Prevention and Control (ECDC) summarizes the results of the C. auris 2024 survey, showing the continued and rapid spread of this pathogenic yeast across Europe, which already reached the state of regional endemicity in some of the countries in only a few (five to seven) years of time. The report counts with valuable input from numerous consulted national experts and emphasizes the importance of national surveillance systems and guidance for infection prevention and control measures.

In the light of the current rapid spread of C. auris in Europe and beyond, this report is highly useful to increase awareness of this growing health problem and to close gaps of national preparedness still existent in several European countries.