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Candida auris

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Candida auris PHAC Guidance Document

Updated August 27, 2026

NCCID Disease Debriefs provide Canadian public health practitioners and clinicians with concise reviews of essential information on prominent infectious diseases for Canadian public health practice. While not a formal literature review, information is gathered from key sources including the Public Health Agency of Canada (PHAC), the World Health Organization (WHO), and peer reviewed literature.

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What are important characteristics of Candida auris infection?

Candida auris (C. auris) is an emerging multidrug-resistant fungal pathogen. It is an important public health concern because it can be difficult to identify, can persist on colonized patients and in healthcare environments for prolonged periods, and can easily spread in healthcare settings. Some isolates are resistant to multiple classes of antifungal drugs, which can make treatment of invasive infection challenging. Healthcare-associated transmission and outbreaks have been documented in Canada. The World Health Organization classifies C. auris as a critical-priority fungal pathogen, and Canada included C. auris for the first time in its 2025 list of priority antimicrobial-resistant pathogens (Tier 1, high priority).

Cause

C. auris is a yeast that can colonize the skin and other body sites and can cause localized or invasive infection. Colonization is generally asymptomatic, but colonized individuals can transmit the organism and contaminate their surrounding environment. Invasive infection can include bloodstream infection and other serious infections and can be life-threatening.

C. auris has been identified in Canada since 2012. The first reported Canadian case of multidrug-resistant C. auris was identified in 2017. The organism is also referred to in recent surveillance literature as Candidozyma auris. Candida auris is retained here as the primary name because it remains the terminology used in Canadian clinical guidance and by WHO.

Signs and symptoms

Colonization with C. auris is generally asymptomatic. When C. auris causes infection, clinical manifestations depend on the site and severity of infection and can resemble those caused by other Candida species. Invasive infection can cause severe disease, including bloodstream infection and sepsis. Fever and chills that do not improve with antibacterial treatment may occur with bloodstream infection, although these findings are not specific to C. auris.

Published estimates of mortality associated with invasive C. auris infection vary substantially. The most recent Canadian surveillance report cites a published range of approximately 15%–60%. These estimates should not be interpreted as a Canadian case-fatality rate, because they are derived from heterogeneous populations and studies.

Who is at increased risk?

C. auris is most often identified in people receiving healthcare, particularly those who are critically ill or immunocompromised. Other factors associated with colonization or infection include exposure to healthcare environments, invasive medical devices, and previous antimicrobial exposure.

Previous hospitalization or receipt of healthcare outside Canada, particularly in settings where C. auris is known to occur, is an important risk factor for colonization or infection. Canadian surveillance from 2020–2024 found that, among cases with available travel information, 15 of 24 had received healthcare abroad. However, one-third reported no travel, so healthcare exposure abroad should not be treated as the only or predominant route of acquisition in Canada.

Transmission

C. auris is primarily transmitted through direct contact with a colonized or infected person or indirectly through contact with contaminated surfaces, equipment or the surrounding healthcare environment. Both colonized and infected individuals can transmit the organism. C. auris can persist on the skin for prolonged periods and can be shed into the environment, where it can contaminate surfaces and equipment. These characteristics facilitate transmission in healthcare settings, including acute-care hospitals and long-term-care facilities.

Healthcare workers can inadvertently contribute to transmission if contaminated hands, clothing or equipment are not appropriately managed. Because colonization may persist and the organism can remain in the environment, prevention depends on early recognition, appropriate precautions, effective cleaning and disinfection, and coordinated surveillance and outbreak response.

Infection prevention and control

Healthcare facilities should follow current provincial or territorial IPC guidance together with the Public Health Agency of Canada’s (PHAC) recommendations for C. auris. PHAC’s current guideline was published in December 2024 and updated in February 2025; it supersedes earlier interim C. auris IPC guidance.

  • Patient placement: Patients colonized or infected with C. auris should be placed in a private room with a private bathroom or dedicated commode, and managed using contact precautions in addition to routine practices. Where a private room is not available, facilities should implement PHAC’s contingency measures.
  • Personal protective equipment: Healthcare workers and visitors entering the patient’s room or care area should use a long-sleeved gown and gloves and perform hand hygiene according to routine practices. Masks and eye protection should be used when indicated by risk assessment or other applicable precautions.
  • Patient movement and transfers: Movement should be limited to medically necessary activities. When transfer is necessary, the receiving facility should be informed in advance. C. auris colonization or infection should not, by itself, be a reason to refuse or delay a medically necessary transfer.
  • Equipment: Patient-care equipment should be dedicated where possible. Reusable equipment should be appropriately cleaned and disinfected before use with another patient.
  • Visitors: Visitors should receive instruction on hand hygiene and appropriate PPE and should follow the same gown and glove precautions while in the patient’s room or care area.

Environmental cleaning and disinfection

Environmental cleaning and disinfection are essential to preventing C. auris transmission. Facilities should use a Health Canada-approved healthcare disinfectant with a claim of efficacy against C. auris and follow the manufacturer’s instructions for use. Quaternary ammonium compounds should not be relied upon for environmental disinfection of C. auris because of their reduced activity against the organism. Chlorine- and hydrogen-peroxide-based disinfectants have demonstrated activity against C. auris in laboratory studies. Ultraviolet-C light and vaporized hydrogen peroxide may be used as supplemental measures in appropriate circumstances but should not replace thorough manual cleaning and disinfection.

Diagnostic challenges

C. auris can be difficult to identify using some conventional laboratory methods. Misidentification may delay appropriate IPC measures and allow transmission to continue. Accurate identification can be achieved using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) with an appropriate, up-to-date database or C. auris-specific molecular methods such as PCR. Older or conventional biochemical identification systems may misidentify C. auris as another yeast species or fail to identify it accurately.

Laboratories should follow current provincial or territorial laboratory guidance. Suspected or confirmed isolates should be referred through the appropriate provincial/reference-laboratory pathway and, where indicated, to the National Microbiology Laboratory. PHAC recommends culture-based methods using chromogenic media for screening specimens, followed by confirmation with MALDI-TOF or PCR.

Screening and case investigation

Screening

Screening can help identify asymptomatic colonization and prevent transmission in healthcare settings. PHAC recommends considering admission screening for patients who have been admitted to a hospital or long-term-care home outside Canada within the previous 12 months, or who have been transferred from a Canadian healthcare facility with an ongoing C. auris outbreak.

Screening specimens should include swabs from the bilateral axilla and groin. Additional sites may be considered based on clinical circumstances, including previously colonized sites and clinically relevant sites such as wounds or device exit sites. For patients meeting admission-screening criteria and for case contacts, if the initial screen is negative, PHAC recommends considering a minimum of two additional screens one week apart, in conjunction with IPC and/or infectious disease expertise. Screening to establish clearance is not recommended, and staff screening is not routinely recommended.

Case investigation

Identification of a confirmed C. auris case should prompt notification of the healthcare facility’s IPC program and the appropriate public health authority, in accordance with jurisdictional requirements. The response should assess the likelihood of healthcare-associated transmission and identify patients or other individuals who may require screening. Investigation should include recent healthcare exposures, transfers between facilities, previous healthcare outside Canada, and potential epidemiological links to other colonized or infected patients. Where transmission is suspected, IPC and public health teams should implement targeted screening, enhanced environmental cleaning and other outbreak-control measures appropriate to the setting.

Treatment and management

Treatment of C. auris infection can be challenging because of antifungal resistance. In Canadian surveillance from 2020–2024, 90.2% of isolates with susceptibility results were resistant to fluconazole, 19.5% were resistant to amphotericin B, and 22% were multidrug resistant. The first Canadian echinocandin-resistant isolate was identified in 2024; it was resistant to fluconazole and micafungin.

Treatment decisions should be based on the site and severity of infection, antifungal susceptibility results where available, and specialist clinical advice. Treatment of asymptomatic colonization is not recommended. Consultation with an infectious disease specialist and/or medical microbiologist is recommended for invasive or otherwise clinically significant C. auris infection.

Epidemiology

C. auris was first described in Japan in 2009 and has since been reported in healthcare settings in countries around the world. In Canada, C. auris has been identified since 2012, while the first reported Canadian case of multidrug-resistant C. auris was identified in 2017.

The latest Canadian national surveillance report, covering 2020–2024, identified 43 C. auris isolates representing colonization and infection. The annual number increased from four in 2020 to 14 in 2024. Of the 43 isolates, 29 (67.4%) were from Central Canada, 12 (27.9%) from Western Canada and two (4.7%) from Eastern Canada. These data come from participating surveillance and reference-laboratory systems and should not be interpreted as a complete count of all C. auris colonization or infection in Canada.

C. auris is relatively uncommon in Canada compared with some other countries, but its detection has increased. The 2025 Canadian AMR prioritization framework identifies C. auris as a Tier 1 (high-priority) antimicrobial resistant pathogen and describes its Canadian trend as low but increasing.

What do we know about C. auris transmission and outbreaks in Canada?

Healthcare-associated transmission and outbreaks of C. auris have been documented in Canada. One of the first reported Canadian outbreaks occurred in a community hospital in the Greater Vancouver area in 2018 and involved four cases. Enhanced IPC measures, including screening and environmental interventions, were used to control transmission.

More recent national surveillance demonstrates continued detection of C. auris, including an increase in isolates identified through participating surveillance systems from four in 2020 to 14 in 2024. However, national surveillance does not provide a complete picture of transmission across all Canadian healthcare settings. PHAC notes that, because of limited data, the current status of C. auris in Canadian hospitals and long-term-care homes remains uncertain. Available evidence therefore supports continued vigilance and preparedness.

PHAC considers any transmission of C. auris among patients within a healthcare facility to be an outbreak requiring additional IPC measures. Outbreak response can include a multidisciplinary management team, epidemiological investigation, enhanced environmental cleaning and disinfection, auditing of hand hygiene/PPE/cleaning practices, contact tracing and screening, and consideration of patient or staff cohorting. Decolonization is not recommended.

Reporting

C. auris is not currently a nationally notifiable disease in Canada. Canada conducts C. auris surveillance through established systems, including CNISP and the National Microbiology Laboratory, even though C. auris is not on the national list of notifiable diseases. However, reporting requirements vary among provinces and territories. Currently, Alberta, British Columbia and Ontario have provincial reporting requirements that identify C. auris as a condition subject to public health reporting.

Healthcare providers and laboratories should follow applicable provincial or territorial requirements and notify their healthcare facility’s IPC program and the appropriate public health authority when C. auris is identified or suspected, as required.

Reporting requirements can change. Users of this evidence brief should consult current provincial or territorial legislation, guidance and public health authorities when determining their reporting obligations.

Canadian surveillance and preparedness

C. auris is included in Canadian antimicrobial resistance and healthcare-associated infection surveillance. CNISP currently conducts surveillance in 109 acute-care hospitals across 10 provinces and one territory—105 of these hospitals participated in C. auris surveillance during 2020–2024. CNISP works with the National Microbiology Laboratory to support national surveillance and characterization.

Canadian preparedness has improved substantially. A 2024 survey of all 109 CNISP hospitals and 32 of 33 associated microbiology laboratories found that 80% of hospitals had admission-screening policies and 95% had policies or defined plans for post-exposure screening. Most laboratories identified all clinically significant Candida isolates to species level, and 75% had standard operating procedures for processing screening specimens. Nevertheless, screening, precaution and laboratory practices remained variable, highlighting the need for continued preparedness and consistent implementation.

References