Candida auris in the Middle East and North Africa: From Emerging Threat to Regional Healthcare Challenge

Candida auris (also termed Candidozyma auris) (C. auris) is an emerging healthcare-associated yeast that has become a major concern because of its persistence in hospitals, frequent misidentification, multidrug resistance, and ability to cause outbreaks in critically ill patients. This review synthesizes the available evidence from the Gulf region, the Eastern Mediterranean region, and North Africa, with emphasis on reported case patterns, epidemiologic expansion, clade distribution, antifungal resistance, colonization-to-infection transition, mortality, and the impact of the COVID-19 period. The Gulf region carries the highest documented burden, with recurrent hospital outbreaks and large surveillance series reported from Saudi Arabia, Qatar, the United Arab Emirates, Kuwait, Oman, and Bahrain. Across the Eastern Mediterranean region, emergence has been more heterogeneous, but major amplification was observed during the COVID-19 era, particularly in Lebanon and Israel. North African data remain more limited, with Egypt and Algeria representing the main published settings; nevertheless, the available findings indicate recent emergence rather than true absence. Across the region, clade I predominates in most countries, suggesting a largely homogeneous South Asian lineage with efficient healthcare-associated transmission. Fluconazole resistance is nearly universal, amphotericin B susceptibility is variable, and echinocandin activity is usually preserved, although resistance to all major antifungal classes has been documented. Colonization often precedes invasive infection, especially among patients with ICU exposure, invasive devices, and prolonged hospitalization. Mortality remains substantial and is highest among patients with bloodstream infection or progression from colonization to invasive disease. The regional pattern is likely driven by a combination of healthcare infrastructure, surveillance intensity, diagnostic capacity, outbreak control, and pandemic-related strain on infection prevention systems.