Genetic Confirmation of Clonal Spread of Candida auris from Southern to Northern Nevada

Candida auris is an emerging fungal pathogen characterized by high levels of antifungal drug resistance and hospital outbreaks in a global distribution. Since introduction to the United States, it has been identified most frequently in New York, Illinois, California, Florida, and Nevada. Its surge poses significant risk as a nosocomial infection with multi-drug resistance, with clades bearing resistance to fluconazole, micafungin, and amphotericin B. Within the state of Nevada, and specifically the greater Las Vegas area in the southern part of the state, there are ongoing outbreaks from clade I and clade III, with 1728 confirmed clinical cases identified as of January 2025. In northern Nevada, three clinical cases have been identified to date, with two occurring at our facility. Both patients had been hospitalized at facilities in Las Vegas, Nevada. The C. auris strains isolated from these two cases have been identified as belonging to clade III and demonstrate resistance to fluconazole. Genome sequencing of the C. auris isolates indicates close genetic identity to strains from the Las Vegas outbreak. These data indicate that the spread of these clonal isolates is due to hospitalization and subsequent patient relocation to northern Nevada, revealing the ongoing importance of screening for geographic spread.