Large Hospital System Experiences Significant Increases in Candida auris
Examined over a 5-year period, the Jackson Health System in Florida reported large volumes of positive cultures for the fungal infection every year and that infection sources expanded over time.
This is a medical illustration of Candida auris fungal organisms, presented in the CDC publication entitled, Antibiotic Resistance Threats in the United States, 2019.
Image Credit: CDC, Stephanie Rossow
The Miami-based Jackson Health System, a nonprofit academic medical organization, saw significant increases in the fungal infection Candida auris every year over a 5-year period (2019–2023).¹ They experienced their largest percentage increase from 2019 to 2020, going from 5 cases in 2019 to 29 cases in 2020. This represents a 590% increase. The health system saw increases every year thereafter, with 71 cases in 2021 (a 145% increase compared to 2020), 107 cases in 2022 (a 51% increase compared to 2021), and 115 cases in 2023 (a 7% increase compared to 2022).¹
This was a retrospective observational study, and its results were published in the American Journal of Infection Control. The investigators included clinical cultures with C auris but did not include surveillance cultures. Specimens were processed through routine methods, and identification was performed using mass spectrometry. Whole-genome sequencing was performed on select specimens, the investigators explained.¹
The predominant source was blood cultures, but the investigators noted that specimens originating from soft tissue and bone infections saw a large increase in 2022 and 2023.¹
“The volumes of clinical cultures with C. auris have rapidly increased, accompanied by an expansion in the sources of infection,” the investigators wrote.¹
They also noted that all the sequenced isolates belonged to clade III (South African) and were found to be resistant to fluconazole but susceptible to echinocandins and amphotericin B.¹
Candida auris Incidence Rates Nationwide
Candida auris continues to increase nationwide. The most recent year of surveillance is 2023, and the Centers for Disease Control and Prevention (CDC) reported 4,514 cases of C auris in the US during that year. The agency also noted that the number of clinical cases has continued to increase since the first US case was reported in 2016. The CDC emphasizes that case numbers and trends vary by state.²
C auris often appears in clusters or small outbreaks within hospitals or long-term care facilities. Three states—Florida (568), California (642), and Nevada (599)—reported the highest number of cases nationwide, followed by Texas (492), Illinois (477), and New York (413). Several Mountain and New England states reported no new cases in 2023.
The CDC explains that state and local health departments submit clinical case count data to the agency. The agency also notes that case counts on some state and local health department websites may differ from federal numbers. For example, the CDC’s webpage currently shows data for clinical cases only, while some states report both clinical and screening cases.
“Differences in counts may also occur because of differences in how cases are counted (such as by case, specimen, or patient; reported date versus specimen collection date; or where the patient lives versus where the patient's sample was collected),” the CDC writes on its website.
