# 616. Patient Demographics and Isolate Characteristics for Candida auris Cases — New York City, 2016–2024

## TL;DR

This study tracks Candida auris cases in New York City from 2016 to 2024, showing rising cases and drug resistance, especially in skilled nursing facilities.

## Contribution

The study provides the first detailed epidemiological analysis of Candida auris cases in NYC, highlighting trends in patient demographics and antifungal resistance.

## Key findings

- Candida auris cases in NYC increased over time, with most clinical cases occurring in patients aged 68 years on average.
- Resistance to fluconazole was detected in nearly all isolates, while amphotericin B resistance increased over time.
- Only 24% of isolates had antifungal susceptibility testing results, indicating a need for improved surveillance and reporting.

## Abstract

Candida auris is a drug-resistant fungal pathogen that can colonize skin and cause invasive infections, typically among patients in healthcare settings. Since C. auris was first reported in the United States in 2016, more cases have been reported in New York than any other state. Laboratory-confirmed C. auris must be reported to the New York City (NYC) Health Department. We characterized the epidemiology of C. auris cases in NYC to guide strategies to prevent transmission.

We examined clinical and public health laboratory-reported C. auris specimens to enumerate screening and clinical cases among NYC residents during 2016–2024 using the Council of State and Territorial Epidemiologists’ 2023 case definition. A person colonized or infected with C. auris is considered colonized indefinitely and counted as a single case; screening cases can later be categorized as clinical cases. We examined age, sex, facility type, and specimen source among cases over time. We described antifungal susceptibility testing (AFST) results for a subset of isolates during 2019–2024.

We identified 8,412 specimens representing 2,256 screening and 2,213 clinical cases. Cases increased over time (Figure 1). Among clinical cases, median patient age was 68 years (standard deviation: 16 years), 60% were male, 37% resided in a skilled nursing facility (SNF), and the most common specimen sources were blood (40%) and urine (21%) (Figure 2). Among 7,334 specimens reported during 2019–2024, 1,795 (24%) included AFST results, representing 863 (45%) of 1,924 clinical cases during this time. Resistance to fluconazole, amphotericin B, or ≥ 1 echinocandin was detected in 99.5% (1,778/1,787), 39.2% (691/1,761), and 1.8% (33/1,784) of isolates, respectively. Thirteen isolates were resistant to fluconazole, amphotericin B, and ≥ 1 echinocandin. Amphotericin B resistance increased over time (Figure 3).

Detection of C. auris cases is increasing in NYC. Focusing infection prevention and control efforts on SNFs might be beneficial. Rising amphotericin B resistance might limit treatment options. AFST results were not available for most isolates, indicating a need for strategies to improve reporting completeness and drug resistance surveillance.

All Authors: No reported disclosures