Antifungal-resistant Candida species in healthcare settings: a regional public health strategy

Antifungal-resistant Candida species have emerged as a significant public health threat in highly interconnected healthcare systems. In recent years, Candida auris and azole-resistant Candida parapsilosis have caused hospital outbreaks associated with high morbidity, mortality and limited therapeutic options, challenging the resilience of healthcare services. Since 2019, and particularly during the COVID-19 pandemic, the Community of Madrid (Spain) has experienced an increase in infections and outbreaks caused by these emerging fungal pathogens, facilitated by intensive care environments, antimicrobial pressure, patient mobility and environmental persistence. In response, the regional public health authorities developed and implemented a comprehensive strategy for the prevention and control of transmission of antifungal-resistant Candida species across all hospitals. This practice-based initiative integrates enhanced epidemiological and microbiological surveillance, early case detection and notification, standardized laboratory identification and antifungal susceptibility testing, molecular typing in outbreak settings, and coordinated infection prevention measures. Key interventions include the systematic use of contact precautions for colonized or infected patients, reinforced hand hygiene, targeted environmental cleaning and disinfection, screening of contacts, and inter-hospital communication supported by a shared surveillance framework. The experience of the Community of Madrid highlights how emerging fungal pathogens challenge health system resilience and underscores the need for coordinated public health responses. Strengthening surveillance systems, laboratory capacity and regional governance is essential to prevent the endemic establishment of antifungal-resistant microorganisms in healthcare settings increasingly affected by global change and healthcare system pressure.

Key messages

• Emerging antifungal-resistant Candida species require integrated surveillance, early detection and coordinated infection prevention measures to reduce transmission in healthcare settings.

• Strengthened public health monitoring, reporting and laboratory capacity are essential for early warning and anticipatory responses to emerging fungal threats.