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. 2025 Sep;31(9):1747-1754.
doi: 10.3201/eid3109.241342.

Increased Incidence of Candida auris Colonization in Early COVID-19 Pandemic, Orange County, California, USA

Alissa H Dratch, Mi Le, Matthew Zahn

Increased Incidence of Candida auris Colonization in Early COVID-19 Pandemic, Orange County, California, USA

Alissa H Dratch et al. Emerg Infect Dis. 2025 Sep.

Abstract

Candida auris transmission surged in long-term acute-care hospitals (LTACHs) in Orange County, California, USA, during the COVID-19 pandemic. This study describes the effect of COVID-19 on C. auris transmission by estimating the probability of patient colonization in LTACHs across 5 epidemiologic time periods. Patients had the highest probability of developing new skin colonization during the first COVID-19 wave, with a cumulative incidence of 22.5% (95% CI 18.5--26.6) after a 30-day stay. Once the initial COVID-19 waves abated, a reduction in cumulative incidence of C. auris colonization was observed concurrently with persistent high prevalence, indicating that within-facility transmission can be reduced with proper infection prevention and control practices. Admission screenings and point prevalence surveys provided a wealth of data that guided public health recommendations and supported the objectives of both public health professionals and LTACHs for monitoring facility transmission dynamics and guiding decision making.

Keywords: COVID-19; California; Candida auris; LTACH; United States; admission screening; competing risks; cumulative incidence; fungus; healthcare-associated infections; pandemic; point prevalence surveys; survival analysis.

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Figures

Figure 1
Figure 1
Flowchart showing cohort swab specimen collection and testing in study of Candida auris colonization early in the COVID-19 pandemic, Orange County, California, USA. LTACH, long-term acute-care hospital.
Figure 2
Figure 2
Seven-day moving averages of new daily COVID-19 cases in Orange County, California, USA, across 5 time periods during study of Candida auris colonization early in the COVID-19 pandemic. Black dot represents beginning of C. auris screening. Horizontal black bar represents period in which COVID vaccines first became available.
Figure 3
Figure 3
Cumulative incidence of Candida auris after 45 days of long-term acute care hospital exposure across 5 periods in study of C. auris colonization early in the COVID-19 pandemic, Orange County, California, USA. Date ranges for each study period are shown in Figure 2.
Figure 4
Figure 4
Point estimates for the cumulative incidence and median prevalence of Candida auris skin colonization in long-term acute care hospitals across 5 periods in study of C. auris colonization early in the COVID-19 pandemic, Orange County, California, USA. Date ranges for each study period are shown in Figure 2. LTACH, long-term acute-care hospital.
See this image and copyright information in PMC

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