Exploratory Evaluation of Chlorhexidine Decolonization and Skin Colonization Dynamics of Candida auris in ICU...

Candida auris has emerged as a nosocomial pathogen in intensive care units (ICUs), and evidence for chlorhexidine-based decolonization remains limited. We report an exploratory pilot study describing skin colonization dynamics in four ICU patients with C. auris infection or colonization who received chlorhexidine decolonization alongside standard infection control measures.

Four consecutive C. auris-positive patients admitted to the ICU of a tertiary teaching hospital in Inner Mongolia, China, between January 31 and March 12, 2026, were enrolled. Two patients (intervention group) received twice-daily 2% chlorhexidine gluconate whole-body skin decolonization; two (non-intervention group) did not, based on family consent. All patients received identical baseline infection control measures. Skin swabs from the nares, axillae, groin, and external ear canals, together with environmental samples, were cultured serially. All isolates were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). For one patient, metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage (BAL) fluid was performed as part of routine clinical workup.

Skin colonization burden declined progressively in both intervention patients: Case A fell from 34 colony-forming units (CFU)/swab at baseline to 4 CFU/swab by Day 12, and Case B from 10 CFU/swab (Day 4) to 5 CFU/swab by Day 6 (discharged on Day 10). Colonization burden did not decline in the non-intervention group (Case C: 24-30 CFU/swab in groin across Day 0-12). Clinical outcomes differed between groups, but the non-randomized design, baseline imbalance in infection status, and universal co-infection with multidrug-resistant organisms preclude any causal inference. C. auris was recovered from 1 of 93 environmental surveillance samples (a suction bottle) and was eliminated by targeted disinfection; no healthcare worker hand cultures were positive.

In this four-patient pilot study, twice-daily chlorhexidine decolonization was accompanied by a reduction in skin colonization burden, but the findings are hypothesis-generating only. The small sample size, non-randomized design, baseline differences, and lack of molecular typing limit interpretation. Adequately powered, preferably randomized, studies with whole-genome sequencing are needed.