Evaluation of persistence of Candidozyma auris colonization

Colonized patients are the main reservoir of Candidozyma auris and drive the increase in prevalence of this resistant pathogen. Solid data on duration of long-term persistence of C. auris colonization are limited, often leading to prolonged contact precautions. The aim of this study was to evaluate the duration of C. auris colonization after discharge from an intensive care unit (ICU) endemic for C. auris.

A single-centre, prospective study was conducted in a hospital where endemic circulation of C. auris was observed in a single ICU. Monthly follow-up skin swabs were scheduled for patients once discharged to other nonendemic wards; after hospital discharge testing was performed during follow-up visits. Composite axilla and groin swabs were tested with PCR and conventional culture. Loss of colonization was defined by two consecutive negative swabs.

From January 2023 to December 2024, 50 C. auris-colonized patients were enrolled. Two or more control swabs were available for 37 patients (74%): 22 of 37 (59.4%) lost C. auris colonization after a median of 5 months (interquartile range 3-7 months, time to the second negative swab). At the last follow-up 14 of 37 patients (38%) were persistently colonized, and 6 of 14 developed candidemia. Lower Karnofsky Performance Status Score at the moment of enrolment and longer administration of antibiotics and antifungals (including for treatment of C. auris candidemia) were associated with persistence of colonization.

When discharged to a nonendemic setting, almost 60% of patients lost C. auris colonization within 5 months after its first detection, suggesting a possible timeframe for re-evaluation of colonization.