Candida auris Urinary Tract Colonization and Nosocomial Infection Control Strategies in Shanghai

Deping Fan,1,* Mengqiu Fu,2,* Mingjing Wei,3,* Yuyuan Xue,3 Jian Guo,4 Dan Qiao5 1Department of Hospital Infection Control, Nanxiang Branch of Ruijin Hospital, Shanghai, People’s Republic of China; 2Department of Hospital Infection Control, Shanghai Xuhui District Dahua Hospital, Shanghai, People’s Republic of China; 3Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China; 4Department of Laboratory Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, People’s Republic of China; 5Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dan Qiao, Email qiaodan840924@163.com Jian Guo, Email guojian1110@126.comBackground: Candida auris is a multidrug-resistant pathogenic fungus that exhibits regional variation and is emerging in new clades worldwide. C. auris predominantly colonizes the urinary tract and respiratory system, thereby increasing the risk of bloodstream infection.Objective: To evaluate the epidemiological characteristics of C. auris urinary tract colonization in Shanghai and assess the efficacy of prevention and control strategies using molecular epidemiology and clinical interventions to provide evidence-based guidance for hospital infection control.Methods: Cases were identified using the ECIFIG Surveillance Network. C. auris isolates from urethral samples were cultured and identified by MALDI-TOF MS combined with ITS sequencing. Antifungal susceptibility was tested using microbroth dilution and YeastOne colorimetric assay. Whole-genome sequencing (WGS) was used to analyze mutations in drug resistance genes, and phylogenetic relationships were determined using SNP-based analysis. The patient received amphotericin B bladder irrigation combined with saline. Active surveillance screened close contacts, environmental surfaces, and hands of healthcare workers. The efficacy of various disinfectants on different surfaces was evaluated to optimize disinfection, and all interventions were guided by comprehensive risk assessment.Results: Between April 2024 and April 2025, C. auris was isolated from the urine samples of 10 long-term bedridden patients with indwelling catheters in Shanghai. All strains were fluconazole-resistant; one strain exhibited amphotericin B resistance, and the other showed echinocandin resistance, harboring the FKS1-S639F mutation. Mutations in ERG11 and CDR1 were also identified. Therefore, amphotericin B bladder irrigation is clinically effective. Environmental monitoring demonstrated that the optimized broad-spectrum composite disinfectant successfully eradicated C. auris. This study demonstrates that the disinfection protocol achieved a success rate of 80% following the intervention, with no subsequent cross-transmission observed.Conclusion: Candida urinary tract by C. auris poses a risk for hematogenous dissemination. Individualized antifungal treatment combined with enhanced environmental disinfection effectively controls colonization and prevents nosocomial transmission, informing hospital infection-prevention strategies. This study is the first epidemiological investigation of C. auris urinary tract colonization in Shanghai, an open metropolitan area in China.Keywords: Candida auris, risk assessment, healthcare-associated infections, infection prevention and control