Candida auris Screening in Organ Transplantation

Candida auris is a multidrug-resistant yeast that poses a disproportionate threat to transplant recipients because of prolonged hospitalizations, intensive immunosuppression, frequent invasive procedures, and exposure to broad-spectrum antimicrobials. Despite growing recognition of its propensity for skin colonization, environmental persistence, and biofilm formation on healthcare devices, standardized screening practices for transplant donors and recipients remain poorly defined. Herein, we review published outbreak reports, surveillance studies, laboratory guidance, and public health recommendations to synthesize current approaches to C. auris screening relevant to transplant populations. Key domains included risk-based criteria for admission and response screening, diagnostic modalities (culture, chromogenic media, MALDI-TOF, and real-time PCR), and the applicability of ICU-derived data to transplant settings. Screening strategies include targeted admission or outbreak-driven response. Culture-based methods remain widely used but are slower and require confirmatory testing, whereas molecular assays enable rapid detection with high sensitivity and specificity and permit timely infection-control responses. Much of the data is extrapolated due to a paucity of transplant-specific evidence; available reports suggest frequent colonization in critically ill transplant recipients and high mortality among those who develop invasive disease. No validated decolonization protocols exist, and perioperative screening is not addressed in most guidelines, creating a gap in peri-transplant risk mitigation. Prospective, transplant-focused studies are needed to define optimal perioperative screening, quantify progression risk from colonization to invasive infection, and evaluate the clinical impact of screening on patient outcomes.