Tracking Candida auris in Communities via Wastewater: Facility-Level Surveillance and Targeted Sequencing

Abstract Candida auris is a multidrug-resistant fungal pathogen that presents substantial challenges for healthcare facilities due to its high mortality rates among vulnerable populations. Six C. auris clades have been identified based on their susceptibility to antifungal treatment and environmental stressors. Identifying the circulating C. auris clade(s) is critical for understanding transmission and selecting a disease control strategy. To inform targeted implementation of community wastewater monitoring for C. auris , samples were collected over 34 weeks from 8 nursing homes and 6 downstream wastewater treatment plants (WWTPs). Detection rates and concentrations of C. auris DNA were significantly higher in samples from nursing homes compared to those from WWTPs. Amplicon sequencing methods were developed and applied to characterize the circulating C. auris clade in a nursing home wastewater sample. This study demonstrates the utility of wastewater monitoring as a resource-efficient approach for detecting and subtyping C. auris in vulnerable communities.