Candida auris in Healthcare Facilities, New York, USA, 2013–2017

Adams, Eleanor; Quinn, Monica; Tsay, Sharon; Poirot, Eugenie; Chaturvedi, Sudha; Southwick, Karen; Greenko, Jane; Fernandez, Rafael; Kallen, Alex; Vallabhaneni, Snigdha; Haley, Valerie; Hutton, Brad; Blog, Debra; Lutterloh, Emily; Zucker, Howard; Workgroup, Candida auris Investigation

doi:10.3201/eid2410.180649

Cited by 286Antifungal resistance and susceptibilityInfection Control in HealthcareYeasts and Rust Fungi Studies

Candida auris in Healthcare Facilities, New York, USA, 2013–2017

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Adams, Eleanor, Quinn, Monica, Tsay, Sharon, Poirot, Eugenie, Chaturvedi, Sudha, Southwick, Karen, Greenko, Jane, Fernandez, Rafael +8 more·2018·Emerging Infectious Diseases

DOI 10.3201/eid2410.180649PMC PMC6154128

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Abstract

Candida auris is an emerging yeast that causes healthcare-associated infections. It can be misidentified by laboratories and often is resistant to antifungal medications. We describe an outbreak of C. auris infections in healthcare facilities in New York City, New York, USA. The investigation included laboratory surveillance, record reviews, site visits, contact tracing with cultures, and environmental sampling. We identified 51 clinical case-patients and 61 screening case-patients. Epidemiologic links indicated a large, interconnected web of affected healthcare facilities throughout New York City. Of the 51 clinical case-patients, 23 (45%) died within 90 days and isolates were resistant to fluconazole for 50 (98%). Of screening cultures performed for 572 persons (1,136 total cultures), results were C. auris positive for 61 (11%) persons. Environmental cultures were positive for samples from 15 of 20 facilities. Colonization was frequently identified during contact investigations; environmental contamination was also common.

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C. auris colonizes the skin of patients for months.
“C. auris has been demonstrated to colonize the skin of patients for months, and to persist as viable in the environment for weeks (Adams et al., 2018; Welsh et al., 2017), which both likely contribute to the nosocomial transmission of C. auris.”
From Murine model of colonization with fungal pathogen Candida auris to explore skin tropism, host risk factors and therapeutic strategies (2021) · cites this paper as Adams et al., 2018
The Results, under Surveillance Cultures (page not provided), report that long-term colonization was common among patients with follow-up cultures; the Figure 3 caption says samples were typically taken from the axilla and groin. Our text does not specify that skin colonization lasted for months, so it supports persistence but not the stated duration. (LLM, conf=0.82)
Experimental — accuracy not yet measured
C. auris skin colonization results in environmental shedding, which underlies hospital transmissions.
“C. auris skin colonization results in environmental shedding, which underlies hospital transmissions, and predisposes patients to subsequent infections.”
From Murine model of colonization with fungal pathogen Candida auris to explore skin tropism, host risk factors and therapeutic strategies (2021) · cites this paper as Adams et al., 2018
The Discussion (page unavailable) identifies prolonged colonization and environmental contamination as possible contributors to transmission in healthcare facilities. Results > Surveillance Cultures documents colonization at skin sites, and the Discussion reports C. auris on room surfaces and equipment. The paper does not establish that skin colonization causes environmental shedding or that this pathway underlies hospital transmission; it presents these factors more cautiously. (LLM, conf=0.85)
Experimental — accuracy not yet measured
C. auris persists as viable in the environment for weeks.
“C. auris has been demonstrated to colonize the skin of patients for months, and to persist as viable in the environment for weeks (Adams et al., 2018; Welsh et al., 2017), which both likely contribute to the nosocomial transmission of C. auris.”
From Murine model of colonization with fungal pathogen Candida auris to explore skin tropism, host risk factors and therapeutic strategies (2021) · cites this paper as Adams et al., 2018
The Discussion says C. auris can remain viable on inanimate surfaces for long periods, citing Welsh et al. It does not specify that viability persists for weeks, so the duration in the claim is not established by this copy. (LLM, conf=0.84)
Experimental — accuracy not yet measured
C. auris is an emerging fungal species responsible for healthcare-associated outbreaks and infections associated with relatively poor patient outcomes.
“Candida auris is an emerging fungal species responsible for healthcare-associated outbreaks and infections associated with relatively poor patient outcomes (1–6).”
From Dual function of Candida auris mannosyltransferase, MNT5, in biofilm community protection from antifungal therapy and the host (2025) · cites this paper as [1]
C. auris persistently colonizes patient skin and adheres to abiotic surfaces, creating reservoirs that enable prolonged transmission in healthcare settings.
“These outbreaks are marked by the pathogen’s ability to persistently colonize patient skin and adhere to abiotic surfaces, creating reservoirs that enable prolonged transmission within healthcare settings9–15.”
From Adhesin Als4112 promotes Candida auris skin colonization through interactions with keratinocytes and extracellular matrix proteins (2025) · cites this paper as [11]

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Emergence and Spread of Candida auris in New York State
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Approach to the Investigation and Management of Patients With Candida auris, an Emerging Multidrug-Resistant Yeast
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LB13. Candida auris in NYC: A Health System’s Experience Treating the Emerging Drug-Resistant Yeast
Mazo, D., Gottlieb, L. B., Schaefer, S. H., Alexander, K., Ehni, J., Javaid, W., Patel, G., Aberg, J. A., & Lorin, S. M. (2018) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofy229.2187 · Cited by 1 · see citing works

Authors: Adams, E., Quinn, M., Tsay, S., Poirot, E., Chaturvedi, S., Southwick, K., Greenko, J., Fernandez, R., Kallen, A., Vallabhaneni, S., Haley, V., Hutton, B., Blog, D., Lutterloh, E., Zucker, H., & Workgroup, C. A. I.
Affiliations: New York State Department of Health (US)
Centers for Disease Control and Prevention (US)
New York City Department of Health and Mental Hygiene (US)
Corresponding author: Lutterloh, Emily
ORCID: Tsay, Sharon
Poirot, Eugenie
Chaturvedi, Sudha
Southwick, Karen
Greenko, Jane
Vallabhaneni, Snigdha
Haley, Valerie
Zucker, Howard
Venue: Emerging Infectious Diseases
Publisher: Centers for Disease Control and Prevention (CDC)
Published: 2018-10
Volume: 24
Issue: 10
Pages: 1816-1824
ISSN: 1080-6040 (ISSN-L)
1080-6059
DOI: 10.3201/eid2410.180649
PMC: PMC6154128
OpenAlex: W2890220120
Cited by: 284
References: 20
Citations by year: 2026: 26 · 2025: 42 · 2024: 34 · 2023: 28 · 2022: 24 · 2021: 27 · 2020: 55 · 2019: 42 · 2018: 6
FWCI: 24.54
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: cc-by
Locations: Emerging infectious diseases (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders: Centers for Disease Control and Prevention (NU50CK000423, U50CK000423)
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Yeasts and Rust Fungi Studies
Keywords: Candida auris, nosocomial infections, outbreak investigation, antifungal resistance, fluconazole resistance, environmental contamination, contact tracing, New York City
MeSH terms: Adult, Aged, Aged, 80 and over, Antifungal Agents, Candida, Candidiasis, Cross Infection, Environmental Microbiology, Female, Health Facilities, Humans, Male, Microbial Sensitivity Tests, Middle Aged, New York, Sentinel Surveillance, History, 21st Century, Young Adult, Public Health Surveillance

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