# Candidozyma auris in The Netherlands: No Evidence of Nosocomial Transmission Supported by Effective Infection Control Policies

## TL;DR

Candidozyma auris cases in the Netherlands are mostly imported, with no evidence of hospital transmission due to effective infection control.

## Contribution

This study provides evidence that C. auris cases in the Netherlands are primarily imported and not transmitted within hospitals.

## Key findings

- All C. auris cases in the Netherlands were imported, with no evidence of nosocomial transmission.
- Most C. auris isolates showed resistance to fluconazole, with some resistance to 5FC and echinocandins.

## Abstract

The yeast Candidozyma auris has emerged globally as a major threat to public health. Outbreaks are frequently reported and difficult to control. In the Netherlands, C. auris is rarely detected although national surveillance has been set up. Here, we present all Dutch C. auris cases reported from March 2018 until April 2025. Antifungal susceptibility testing (AFST) using broth microdilution and whole genome sequencing (WGS) were conducted to evaluate antifungal resistance and genetic relatedness. A total of 26 cases of C. auris infection or colonization were reported across 22 different medical institutions in the Netherlands. Most patients had a history of travel to countries with prior reports of C. auris and were hospitalized in foreign medical centers. All patients were admitted in isolation, and all but one remained in isolation for the duration of their hospitalization. WGS showed isolates belonged to clade I or III. Analysis of travel history, contact tracing and WGS data showed no evidence of nosocomial transmission. All isolates were non-wild type to fluconazole with many harboring corresponding mutations in ERG11. One isolate was non-wild type to 5FC and another one to echinocandins including rezafungin. The latter harbored a FKS1F635Y mutation and was imported from Greece. To conclude, C. auris cases are steadily increasing in the Netherlands. Nonetheless, until now cases seem solely imported from abroad with no evidence for nosocomial transmission. This can be attributed to effective infection prevention and control policies. The C. auris isolates were all non-wild type for fluconazole and a single isolate was non-wild type for echinocandins.

The online version contains supplementary material available at 10.1007/s11046-025-01024-7.