Yeast fungus C. auris is spreading in Germany – and is becoming increasingly dangerous
The multidrug-resistant pathogen Candidozymas auris continues to spread, according to a new EU report. Experts say this is "alarming" for Germany. Here are the most important questions and answers.
Candidozymas auris (formerly known as Candida auris) has been spreading rapidly in Europe and Germany for years. Between 2013 and 2023, more than 4,000 cases of C. auris were identified in EU countries and countries within the European Economic Area, including over 1,300 cases in 2023 alone.
Germany is among the countries with the highest number of cases, according to a new report from the European Centre for Disease Prevention and Control (ECDC).
According to the ECDC, the rapid spread is "cause for great concern," although it only reflects the "tip of the iceberg" – because in many countries the pathogen is not systematically monitored.
Between 2013 and 2023, 120 cases of C. auris were reported in Germany. Of these, 77 cases occurred in 2023 alone – about six times as many as in previous years.
However, only about 20 percent of cases in Germany are infections. According to Oliver Kurzai, head of the Institute of Hygiene and Microbiology at the Julius-Maximilians-University of Würzburg, the rest are so-called "colonization cases." This means the pathogen is detected, but the people do not require treatment.
The fact that Germany is among the countries with the highest numbers is primarily due to the fact that there is "almost complete recording of all cases" in this country. According to the expert, the number of unreported cases is particularly low in Germany. "This distinguishes us from many other countries in the report, which are really only seeing the tip of the iceberg," Kurzai summarizes.
Importantly, the expert emphasizes that while the numbers are rising, they are still low overall. As head of the reference center in Germany, he was personally involved in the data basis for the report . "There are many things you're rightfully concerned about when you come to the hospital, but Candidozyma auris shouldn't be on that list. It's currently a rarity in Germany." For individual patients, the probability of coming into contact with it remains low.
C. auris primarily infects weakened individuals, such as those in intensive care units or nursing homes. It generally does not affect healthy people.
Transmission occurs through contact infections. "That means, usually indirectly, from a colonized or infected patient to another patient," explains Kurzai. However, medical personnel and medical devices used directly on patients can also transmit the fungus: "All kinds of devices that are difficult to disinfect and that are used on multiple patients. That's the most important transmission route," says Kurzai. This route is no different from other problematic pathogens in hospitals, such as the multidrug-resistant MRSA pathogens.
The symptoms of an infection are nonspecific and, according to Kurzai, "uncharacteristic." Depending on where the infection is located, the infection manifests differently.
A bloodstream infection, in which the pathogens are detected in the blood, can, in the worst case, lead to sepsis (blood poisoning). This manifests itself, for example, in
- Fever,
- acute confusion,
- shortness of breath,
- low or falling blood pressure
- and rapid pulse.
The pathogens can also
- Ear infections with pain, itching and overheating
- Wound infections with redness, swelling and pain
and cause painful urinary tract infections with burning, urinary urgency and cloudy urine.
In some countries, such as India, C. auris is already endemic. There, it is considered one of the most common pathogens of candidemia, fungal infections of the bloodstream, reports Birgit Willinger, head of the Clinical Department of Clinical Microbiology at the Medical University of Vienna and head of the National Reference Center for Yeasts and Molds in Austria.
The expert sees the fungus as particularly problematic because it can be highly resistant to conventional antifungals, such as fluconazole. This complicates treatment. Furthermore, it is difficult to eradicate and easily spreads from person to person. "If you don't react in time, you'll experience an outbreak of infections, as we've seen in several countries," says Willinger.
According to Kurzai, countries like India are showing where the situation is "inevitably" headed. "Candidozyma auris then begins to displace other Candida species, and that, I always say, is bad news. We are replacing easily treatable pathogens that don't spread from patient to patient with a pathogen that can become resistant and spreads from patient to patient," Kurzai worries.
Although he is convinced that this cannot be prevented in the long term, he is optimistic that it can be slowed down and delayed for a very long time.
Southern European countries, in particular, are reporting high numbers of C. auris infections. Most cases were reported in Spain, followed by Greece, Italy, and Romania. These countries reported that they can no longer distinguish whether these are isolated outbreaks or an endemic situation.
"This is, of course, alarming for countries like Germany and Austria," Kurzai comments on this observation. "We have a lot of people vacationing in Southern Europe. And if they come into contact with the hospital system there, there's a risk that this pathogen will be increasingly introduced to us as well."
For Willinger, this primarily argues for more frequent patient testing for the fungus. "If you know these patients come from a hospital where there is or has been an outbreak, you should definitely screen them and check immediately upon admission whether Candidozyma auris can be detected there." The expert emphasizes that it is particularly important to react immediately in such cases.
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