Candidozyma auris: “The Silent Colonizer” mapped through 15-month surveillance in a North Indian tertiary-care hospital

Background Candida auris (reclassified as Candidozyma auris ) is an emerging multidrug-resistant fungal pathogen associated with healthcare-associated outbreaks. Its persistence in healthcare environments and frequent misidentification pose challenges for infection prevention. This study aimed to estimate ICU colonisation prevalence, reassess non-albicans Candida (NAC) isolates using molecular diagnostics, and conduct targeted ward surveillance. Methods A prospective surveillance study was conducted from September 2022 to December 2023 across six ICUs of a tertiary care hospital in Jammu & Kashmir. Monthly axilla-groin composite swabs were collected, with rescreening of patients remaining admitted during subsequent rounds. Targeted surveillance was undertaken in wards where C. auris was recovered from sterile-site specimen. Identification used HiCrome Candida differential agar (HCDA), VITEK® 2 Compact, and species-specific PCR. Antifungal susceptibility testing (AFST) was performed by E-test. Results Twenty unique patients were colonised with C. auris , giving an overall ICU colonisation prevalence of 4.1%. Ten additional unique patients were identified through targeted surveillance and were not included in the ICU denominator. Thus, 30 unique patients were identified. Of 120 non- albicans Candida isolates, PCR confirmed 54 C. auris , including eight misidentified by VITEK 2. All isolates met the CDC tentative resistance threshold for fluconazole, while no echinocandin resistance was detected. Amphotericin B resistance occurred in 4/54 (7.4%) isolates. Voriconazole MICs >32 μg/mL occurred in 7/54 (13.0%) isolates and were reported descriptively. Sixteen (53.3%) patients with C. auris expired. Conclusion Fifteen-month surveillance identified ICU colonisation and highlighted limitations of phenotypic identification. Molecular confirmation and continued surveillance are important for early recognition of C. auris and infection control.