C. auris in Wastewater: Current Evidence, Risks, One Health Implications, and Knowledge Gaps

Candidozyma aurisauris (formerly Candida auris) is an emerging, multidrug-resistant fungal pathogen that is difficult to identify and has become an increasing challenge for global public health. In recent years, its detection in wastewater has raised concerns regarding the potential environmental dimensions of its dissemination and the associated public health implications. This study examines the current evidence on the occurrence of C. auris in wastewater, with an emphasis on the concentration, isolation, and identification methodologies employed in recent investigations. Framed within a One Health perspective, the analysis discusses potential pathways of environmental dissemination through wastewater effluents and biosolids, particularly in the context of the expanding reuse of treated wastewater and the land application of sewage sludge. The review also highlights existing regulatory gaps, including the absence of specific guidelines addressing pathogenic fungi in wastewater treatment plant byproducts as well as the lack of standardization in reported data, which hinders more in-depth analyses. Overall, this work identifies important knowledge gaps and emphasizes the need for further studies and interdisciplinary surveillance strategies to better understand the environmental circulation of C. auris. Additionally, a conceptual workflow is proposed to advance the standardization of analytical approaches and data reporting, contributing to strengthening public health, environmental protection, and sanitary policies.