Absence of community-acquired Candida auris colonization among newly hospitalized participants without recent healthcare exposure from a cross-sectional study in Dhaka, Bangladesh

Abstract

ABSTRACT Candida auris (C. auris), an emerging fungus, is primarily recognized for causing healthcare-associated infections. While carriage among hospitalized patients is well documented, community spread remains poorly understood. This study aimed to determine the burden of community-acquired C. auris skin colonization among newly hospitalized participants without any recent healthcare exposure. This cross-sectional study was conducted at two tertiary-level government hospitals and their surrounding catchment areas in Dhaka, Bangladesh, from June 2023 to May 2024. We enrolled 800 participants (400 from each hospital) shortly after admission, meeting the following criteria: no healthcare exposure within the past three months, no invasive procedures performed since the current hospital admission, and residence within the hospital’s catchment area for the past three months. Skin swabs from the axillae and groins were cultured on CHROMagar Candida Plus to determine fungal colonization. Presumptive positive isolates were identified using VITEK 2, and C. auris was confirmed by whole-genome sequencing. No C. auris colonization was detected in the axillary or groin in any enrolled participant. However, 128 (16%) patients were found to be colonized with other fungal species. The absence of community-acquired C. auris colonization in this study suggests that transmission primarily occurs within hospital settings. However, our strict inclusion criteria, which excluded patients with recent healthcare exposure, may have influenced this finding. Further research using alternative study designs is needed to fully understand the potential for C. auris spread within the community.IMPORTANCECandida auris, a rapidly emerging multidrug-resistant fungal pathogen with high mortality, poses a critical global health threat, particularly in healthcare settings. While extensive research has focused on its colonization among hospitalized patients, its potential presence and community transmission remain largely unexplored. An earlier study among critically ill patients in Bangladesh detected four colonized cases of C. auris without hospitalization history within the past year and admitted directly from home (F. Chowdhury et al., unpublished data). Notably, three participants resided in the same district and one in an adjacent district, raising serious concerns about possible community spread. This study is crucial in addressing this knowledge gap by assessing the burden of community-acquired C. auris colonization among newly hospitalized patients in Dhaka. Understanding its potential transmission outside the hospital is vital for shaping public health responses, guiding infection control strategies, and strengthening global surveillance efforts to mitigate the spread of this highly resistant pathogen.

Keywords

• Candida auris
• emerging fungus
• colonization
• community-acquired
• Bangladesh