Candida auris in the United States, 2022–2024: Clinical and Screening Cases Keep Rising

The yeast and why it is tracked

Candida auris is an emerging yeast that is often resistant to antifungal drugs. It can cause invasive infections with high mortality, and it can also colonize patients — live on skin or mucous membranes without causing illness — which lets it spread quietly in health care settings. It persists on surfaces, and spreads especially in acute care hospitals (ACHs), long-term acute care hospitals (LTACHs) and skilled nursing facilities (SNFs) equipped with ventilators.

• Symptoms are nonspecific and depend on where the infection is and how severe: from superficial skin infections to invasive ones such as bloodstream infection (candidemia).
• Treatment: most isolates resist the common azole fluconazole, so echinocandins are first-line. Echinocandin-resistant and multidrug-resistant strains (resisting azoles, echinocandins and polyenes) have been found in the United States; echinocandin resistance is still uncommon, but such strains narrow the options.
• Risk factors for colonization and infection: frequent or long stays in health care facilities, complex care with invasive devices (mechanical ventilation, central venous catheters), and recent antimicrobial use.

Screening high-risk patients for colonization is central to prevention, because it lets a facility put the recommended infection control measures in place. Facilities decide whom to screen from local epidemiology, links to other cases (such as the same unit), patient risk factors and the purpose of screening — either a point prevalence survey of everyone on a unit or facility, or targeted screening.

The first U.S. cases were reported in 2016. Early ones were mostly linked to health care abroad; most recent ones were acquired in U.S. health care settings. Reported clinical cases grew from about 50 in 2016 to about 1,500 in 2021, the largest yearly jump (95%) coming from 2020 to 2021. In some states the yeast is now endemic; others are just reporting their first cases. This CDC report covers cases with specimens collected in 2022–2024.

How cases are counted

Following the Council of State and Territorial Epidemiologists' 2023 case definitions:

• a clinical case is C. auris found in a specimen taken to diagnose a suspected infection — blood, which usually means invasive infection, or another type such as urine, which may be infection or colonization;
• a screening case is C. auris found on a colonization swab, most often a composite of armpit and groin, or nostrils, armpit and groin.

A patient can count as at most two cases — one screening case and then one clinical case — and only the first specimen of each type counts.

State and local health departments report voluntarily, through the REDCap database or CDC's cloud platform DCIPHER, with age, sex, case type, specimen type, collection date, facility type, and the region of CDC's Antimicrobial Resistance (AR) Laboratory Network. Clinical cases have been nationally notifiable since 2019, screening cases since 2023. The data, current as of February 20, 2026, come from CDC's case-based system rather than the National Notifiable Diseases Surveillance System, because only the former records facility type. Because blood isolates are almost always identified to species while other specimens depend on local lab practice, the year-by-year look at specimen type focuses on blood.

The analysis is descriptive: with no denominators, and testing that varied across places and years, it describes reported cases, not how common the yeast is in the population.

Clinical cases: 13,507

• Age: 87.8% were 45 or older — 32.2% aged 45–64, 29.5% 65–74, 19.6% 75–84, 6.5% 85 or older; 12.0% were 18–44 and 0.2% under 18.
• Sex: 61.0% male.
• Specimen: urine 31.5%, blood 30.2%, wound 16.7%, respiratory 13.1%.
• Region: West 28.5%, Midwest 21.3%, Southeast 20.2%.
• Facility: ACHs 76.6%, LTACHs 17.8%, SNFs 1.7%.

Among cases from blood, age, sex and facility patterns held steady across the years; the Northeast's share fell from 21.8% to 13.7%. Facility type was the most-often missing field — for 13.1% of clinical cases.

Screening cases: 27,853

Screening cases rose from 6,226 in 2022 to 9,195 in 2023 and 12,432 in 2024.

• Age: 90.0% were 45 or older.
• Sex: 57.9% male.
• Region: West 36.0%, then Southeast and Midwest (18.8% each).
• Facility, overall: LTACHs 42.1%, ACHs 41.8%, ventilator-equipped SNFs 10.3%.

The setting shifted. Among the 87.5% of screening cases with a known facility type:

What the numbers suggest

The growth is slowing, but the counts keep climbing. The steep 2021–2022 jump may reflect the COVID-19 pandemic's strain on health care — shortages of supplies and staff, overcrowding — along with heavy use of broad-spectrum antibiotics for secondary infections and more critically ill patients on ventilators with long stays. The smaller rises since may reflect a renewed focus on standard protocols once protective equipment and staffing recovered. Better lab capacity — more species-level identification, updated testing libraries — and more screening may also have raised detection. The data cannot say how much each factor contributed.

Clinical cases came mostly from specimens in ACHs and LTACHs, though the data do not show where transmission happened. About a third came from blood, which signals invasive infection — worrying, given frequent drug resistance and a mortality of 30%–72%. Trends in non-blood specimens should be read with caution, since labs have increasingly identified yeast from sources such as urine. Why cases skew male is unclear and was not studied.

Screening first targeted LTACHs and ventilator-equipped SNFs, whose patients — on ventilators, with long stays and serious conditions — carry the highest risk. The move toward acute care hospitals is uncertain in cause, but may reflect screening at admission: an ACH can find a patient who was colonized at another facility. National notifiability from 2023 may also have made reporting more complete. Faster, more sensitive PCR tests and wider adoption of CDC's guidance on targeted and facility-wide screening may have added to the rise, which makes it hard to separate true spread from more looking.

What CDC recommends

• Strict infection prevention and control, backed by state, local and federal guidance, technical help and site visits.
• Hand hygiene, and disinfectants effective against C. auris wherever patients with it are cared for.
• Transmission-based precautions: contact precautions in ACHs and LTACHs; contact precautions or enhanced barrier precautions in nursing homes and SNFs, depending on the setting and local recommendations.
• Regular audits of infection control practice, and telling the next facility a patient's C. auris status at transfer.
• Facilities able to care for patients with other multidrug-resistant organisms or Clostridioides difficile can generally care for patients with C. auris as well.

Limits of the data

• Counts can differ from those states and localities publish, because systems, definitions, inclusion rules (cases, specimens or patients), residence versus collection site, and report versus collection dates differ.
• A clinical case is defined by the specimen's purpose, not by evidence of infection, so urine and respiratory specimens may be colonization.
• With no denominators — patients tested, facilities taking part, census — incidence and prevalence cannot be estimated, and changes may reflect how hard people looked.
• The counts likely understate the true prevalence: colonized patients may go unscreened, and some infections go undetected.
• Changes in reporting rules and testing practice may have shaped the trends.
• The system records no negative results, race, ethnicity, socioeconomic data, treatments, outcomes or susceptibility testing.

Where next

Laboratory capacity — for identifying C. auris and testing its drug susceptibility, through the AR Laboratory Network and clinical and commercial labs closer to patients — would speed detection and reveal shifts in resistance. Better surveillance could show which screening approaches work best and what drives the step from colonization to infection. Research could pursue decolonization and other ways to cut the risk for colonized patients, better antimicrobial use, and new antifungal drugs for resistant strains.

Bottom line: C. auris remains a serious U.S. health threat, found mostly in middle-aged and older adults in acute and long-term acute care hospitals. Clinical cases roughly doubled from 2022 to 2024, and although each year's rise was smaller than the last, the continued increase points to ongoing spread in health care settings.

More: CDC on clinical treatment, screening, infection control and tracking C. auris.

Sources

Based on "Surveillance for Candida auris — United States, 2022–2024," MMWR Surveillance Summaries volume 75, Centers for Disease Control and Prevention, as corrected by its erratum; corresponding author Jeremy A. W. Gold, CDC; a work of the United States government in the public domain.