Sustained Clearance of
                    <i>Candida auris</i>
                    Colonisation After Hospital Discharge: A Community Follow‐Up Cohort Study

doi:10.1111/myc.70227

DOI: 10.1111/myc.70227 ISSN: 0933-7407

Sustained Clearance of Candida auris Colonisation After Hospital Discharge: A Community Follow‐Up Cohort Study

Isabel De‐Jesus‐Maria, Mercedes Melero‐García, Jose Luis Mayordomo, Carme Salvador, Ignacio Barreira‐Franch, Adriana Agurto‐Ramírez, Concepción Gimeno, Jose Luis Alfonso‐Sanchez

Show PDF Cite

ABSTRACT

Background

Candida auris (reclassified as Candidozyma auris) is an emerging multidrug‐resistant yeast that readily spreads in healthcare settings. The duration of colonisation and the feasibility of sustained clearance after discharge remain uncertain.

Objectives

To estimate time to sustained clearance of C. auris colonisation after hospital discharge and to assess durability of sustained negativity.

Methods

We conducted a longitudinal observational cohort study in a tertiary‐care hospital including patients with ≥ 1 C. auris –positive clinical or screening specimen during admission (2018–October 2023) who were discharged to the community. Community follow‐up sampling for skin carriage was performed from December 2023 to July 2025 (≥ 3‐month intervals). Follow‐up samples underwent fungal culture with MALDI‐TOF identification and RT‐PCR; sampling episodes were classified as negative only when all collected sites were negative by both methods. Clearance was defined as two negative sampling episodes ≥ 7 days apart with no subsequent positives. Time to clearance was modelled using an interval‐censored accelerated failure time (AFT) model assuming a lognormal distribution, reporting time ratios (TR).

Results

Among 156 participants, median age was 61.4 years (IQR 52.1–73.5) and 32.7% were female. Forty‐four patients (28.2%) provided no post‐discharge samples (right‐censored); 112 provided follow‐up samples, of whom 96 achieved sustained clearance and 16 remained colonised during follow‐up. In the final multivariable AFT model, pharyngeal colonisation was associated with longer time to clearance (adjusted TR 2.53, 95% CI 1.28–5.00). For a typical patient profile, adjusted median time to clearance was 6.1 months (95% CI 3.9–10.1); persistence of clearance was 16.5 months (IQR 11.5–26.9).

Conclusions

In a community setting, sustained negativity after discharge was common. Although the estimated time to clearance should be interpreted cautiously because of heterogeneous follow‐up initiation, our findings indicate that sustained clearance is achievable and may persist over prolonged follow‐up.

Outline