In medicine, “interesting” is rarely a compliment. So when Mary Hayden, MD, describes Candida auris as one of the most interesting organisms she’s encountered in her career, it’s not praise — it’s a warning.
“You never want to be interesting in medicine, and interesting oftentimes is bad,” said Dr. Hayden, head of infectious diseases at Rush University System for Health, who has tracked the fungus since it first appeared in Chicago nearly a decade ago.
Clinical C. auris cases more than doubled from 2022 to 2024, according to a July 2 CDC report, rising from 2,882 to 6,197 nationwide. Screening cases nearly doubled as well over the same period, climbing from 6,226 to 12,432. Clinical cases had already jumped more than 50% from 2022 to 2023, and by late 2025 the U.S. had recorded 7,045 cases, driven largely by Nevada and California — the two states that have consistently led the nation in case counts. A 2023 CDC report found a 34% mortality rate among hospitalizations tied to the fungus.
For infection prevention leaders in Chicago, one of the earliest U.S. regions affected by C. auris, the national trajectory tracks closely with what they’re seeing on the ground.
“We continue to see an increasing number of both symptomatic clinical cases and infections due to that organism,” Dr. Hayden said. “We are seeing more of this across the Chicagoland area.”
Dr. Hayden suspects those national figures still understate the true scope of spread. “Some states have yet to report any C. auris cases at all,” she said, “and I suspect that’s not because they haven’t had it, but because they just don’t know about it.”
At Northwestern Medicine, also based in Chicago, the trend aligns with both local and state-level data, said Rachel Weber, infection preventionist. “Our impression is that it’s really a multitude of factors driving the increase,” Ms. Weber said, pointing in part to expanded surveillance. Christina Silkaitis, director of infection prevention at Northwestern Medicine, agreed: More facilities, especially long-term care sites that previously lacked screening programs, are proactively testing for the organism.
Why C. auris is different
Dr. Hayden said C. auris stands out among fungal pathogens because it behaves less like a typical yeast and more like a multidrug-resistant bacterium, spreading patient to patient in the way MRSA or NDM-producing E. coli do.
“There’s no other yeast that I’m aware of that does that,” she said. The organism spreads both within facilities, through contaminated surfaces or healthcare workers’ hands, and between them, as colonized or infected patients transfer from nursing homes to hospitals and back. Within hospitals, Dr. Hayden said outbreaks have clustered in intensive care units and, in particular, specialized units such as burn units and heart and lung transplant units.
That mobility, combined with the organism’s resilience, makes detection difficult. While a single nasal swab can identify roughly 90% of patients colonized with Staphylococcus, Dr. Hayden said it takes swabbing six different body sites to approach full detection of C. auris colonization. Rush currently swabs the armpit and groin, sometimes adding the nose, which she said still captures only about 80% of colonized, asymptomatic carriers.
“The skin looks clean, so you may go and shake some patient’s hand, or as a healthcare worker or even a visitor,” she said. “But you could then pick up Candida auris on your hand and spread it around.”
What’s making a difference
Both systems pointed to layered, multidisciplinary approaches rather than any single fix.
Northwestern has run admission screening for patients arriving from long-term care facilities and skilled nursing facilities since 2019, pausing for about a year and a half during the COVID-19 pandemic, and has since added weekly screening on units with high C. auris prevalence. Illinois’ XDRO registry, a state database that flags patients with a history of multidrug-resistant organisms on admission, has been “really impactful,” Ms. Weber said. So has a weekly, multidisciplinary epidemiological surveillance subcommittee — spanning infection prevention, the lab, antimicrobial stewardship and infectious diseases — that Ms. Silkaitis said has met for more than 30 years.
At Rush, single-patient rooms and routine use of a disinfectant effective against C. auris have helped limit spread, Dr. Hayden said. The system is preparing to launch a new admission screening program for high-risk patients. Rush is also testing decolonization strategies, including an over-the-counter iodine compound in the nose combined with chlorhexidine bathing — an approach showing some, but not complete, reduction in colonization.
Persistent barriers
Early identification remains the biggest obstacle, both systems said.
“The continuous identification as they’re going back and forth between healthcare facilities is critical,” Ms. Silkaitis said, so patients can be isolated immediately on arrival.
Dr. Hayden pointed to a second, related challenge: growing antifungal resistance. Rush has tracked increasing resistance to standard antifungal agents since 2016, compounding the difficulty of treating infected patients even after they’re identified.
Both Ms. Silkaitis and Ms. Weber pointed to better interfacility communication as the clearest need for hospitals nationally. Dr. Hayden said the biggest gap is federal funding for research into effective decolonization regimens, since no reliable option yet exists to clear the organism from colonized patients the way some regimens do for MRSA.
Looking ahead, none of the three expect case counts to fall soon.
“I think it’s going to increase before it plateaus,” Ms. Weber said, noting that expanded screening will likely surface more cases even as it helps contain them. Dr. Hayden was similarly direct. “Unfortunately, I think that case counts are going to keep climbing until better decolonization tools exist,” she said.
For hospitals that haven’t yet seen a significant case, the advice from both systems is the same: don’t wait. “Just being vigilant and having a plan is a very important step,” Ms. Silkaitis said. Dr. Hayden added that hospitals should tailor their approach to their region’s epidemiology, but that admission screening of high-risk patients is a reasonable starting point almost everywhere.
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