Health Update

January 26, 2026

The Missouri Department of Health & Senior Services (DHSS)
continues detecting an increased number of cases of Candida auris (C. auris) within health care facilities across the state of Missouri. DHSS first identified locally acquired C. auris infection in October 2023.

Summary

Figure 1. C. auris Cases Detected in Missouri by Month, October 2023-November 2025

With the ongoing spread of C. auris to new geographic regions, additional concerns have been raised to the DHSS Healthcare Associated Infections/ Antimicrobial Resistance (HAI/AR) Program. As colonization screening efforts for C. auris have grown, there is an increased likelihood that any healthcare facility type may encounter an individual with C. auris. All healthcare facilities types should be prepared to accept and care for patients infected or colonized with C. auris. This Health Update provides further guidance for household members and caregivers, additional facility types, clarifications on transmission-based precautions, and ready-for-use inter-facility communication tools.

C. auris Background

C. auris is yeast that, due to resistance to many antifungal drugs, is considered an urgent antimicrobial resistance threat by the Centers for Disease Control and Prevention (CDC). C. auris spreads easily in health care settings and is difficult to treat due to drug-resistance. Invasive infections with C. auris are particularly concerning and have caused death in about one in three persons who developed severe disease due to this infection. According to the CDC’s C. auris tracking tool, there were 4,514 clinical cases and 9,287 colonization/ screening cases identified from January 2023 – December 2023 across 37 states.

Risk Factors

1. C. auris mostly affects individuals with severe underlying conditions, those requiring complex medical care, as well as those with indwelling devices. Patients with invasive medical devices like breathing tubes, feeding tubes, catheters in a vein, or urinary catheters tend to be at increased risk for acquiring C. auris infection. Healthy individuals without these risk factors, including health care workers and household family members, have a low risk for becoming infected with C. auris.

 Transmission

1. C. auris can spread from one patient to another in health care settings. It can spread through close contact with infected or colonized patients and contaminated surfaces or equipment. C. auris can live on surfaces for several weeks. Contact with these surfaces allows the fungus to spread to other people. Once a patient has tested positive for C. auris infection or colonization, they are considered colonized for life and infection control measures should be utilized indefinitely.

Symptoms and Colonization

1. C. auris can cause infections in different parts of the body such as in the bloodstream, open wounds, and ears. The symptoms depend on the location and severity of C. auris infection. Symptoms may be similar to an infection caused by bacteria. There is not a common set of symptoms specific for C. auris infections. People can get C. auris on their skin and other body sites without getting sick or having an active infection with symptoms. Health care providers may refer to this as ‘colonization.’ Someone who is colonized can still contaminate surfaces or objects they contact with C. auris, which can then be spread to other patients.

Diagnosis

Health care providers can diagnose a patient as actively infected or colonized with C. auris in two ways:

• Colonization screening– a health care provider swabs the patient’s skin by rubbing a swab near the armpits and groin and sends the swab to a laboratory for testing.
• Clinical specimen testing– If a patient is showing symptoms of an infection of an unknown cause, a health care provider may collect a clinical sample, like blood, urine, or wound. Such tests can detect many different infections, including those caused by bacteria, as well as infection with C. auris.

Retesting patients infected or colonized with C. auris is not recommended and should not be used to change infection control measures. A negative test after a previous positive does not ensure that the patient no longer has C. auris on their skin or other body sites and will not spread it to others.

Treatment

Some C. auris strains have been resistant to all three main classes of antifungal medicines, meaning none are able to treat the infection. In this situation, multiple antifungal medicines or newer antifungals may be used to treat the infection. Most strains of C. auris found in the United States have been susceptible to echinocandins, although reports of echinocandin-resistant (or pan-resistant) cases are increasing. Patients who are colonized (have C. auris detected on their body but do not have symptoms of infection) should not be treated with antifungals for C. auris. There is no evidence that treatment of colonization prevents future illness.

Epidemiology of C. Auris in Missouri

C. auris was first detected in Missouri in late 2020. There were only few new cases detected until 2024. Between July 1, 2024, and November 30, 2025, DHSS has detected 757 additional cases with both clinical and screening cases identified across the state. At least one C. auris case has been detected in a variety of health care facilities including: Acute Care Hospitals, Long Term Acute Care Hospitals, Skilled Nursing Facilities, Assisted Living Facilities, and Rehabilitation Hospitals. Additionally, some C. auris positive patients have also been receiving healthcare through hemodialysis and home health services. Patients may be identified in one healthcare facility and subsequently seek healthcare from other facilities, especially when seeking care further away from home (i.e. transferred for higher level of care, hospitalized during travel, etc.).

Cases Continue to be largely identified through point prevalence surreys (PPS) conducted by health care facilities as part of epidemiologic investigation and public health surveillance.  Colonized individuals have been detected via axilla/groin and rectal swabs.  Clinical cases have been identified from positive test of abdominal aspirate, blood, bile, bronchial wash, peritoneal dialysis fluid, sputum, tissue, urine and wounds, among other.

From the 829 cases reported in Missouri since 2023:

• Patient age ranges from 7 months to 99 years old, with 50.8% being 65 or older. See Table 1 (below)
• 63.4% of cases are reported as male

Figure 2. Number of C. auris cases detected in Missouri by Quarter, Q1 2023- Q4 2025*

Missouri DHSS Recommendations

Infection Prevention and Control

The CDC and the Missouri DHSS recommend health care facilities take the following actions to identify and control further spread:

• Immediately initiate and regularly reinforce appropriate use of transmission-based precautions based on the setting (described below).
• Inform and educate appropriate personnel about the presence of a patient with C. auris and the need for rigorous adherence to infection control practices.
• Ensure strict adherence to hand hygiene and appropriate personal protective equipment (PPE) use. Alcohol-based hand sanitizer is effective against C. auris and is the preferred method for cleaning hands when they are not visibly soiled. Wearing gloves is not a substitute for hand hygiene.
• Perform thorough cleaning and disinfection of the patient care environment and any shared equipment (daily and terminal cleaning) used by patients with confirmed or suspected C. auris. Use a disinfectant active against C. auris identified by the Environmental Protection Agency (EPA) from EPA List P.
• If possible, use dedicated medical equipment for patients with confirmed or suspected C. auris.
• Promote antimicrobial stewardship to limit the emergence of C. auris and other multidrug-resistant organisms (MDROs).

Transmission-Based Precautions

Health care facilities should not decline admission based on colonization or presence of MDRO infection including C. auris. All patients with C. auris infection or colonization should be placed on the appropriate transmission-based precautions based on the setting:

• Acute care hospitals, post-acute care facilities (including long-term acute care hospitals) should place patients with C. auris on contact precautions.
• Skilled Nursing Facilities should place patients on Enhanced Barrier Precautions (when contact precautions do not otherwise apply). More information on enhanced barrier precautions can be found here: https://www.cdc.gov/long-term-care-facilities/hcp/prevent-mdro/ppe.html
• Skilled nursing facilities with ventilator units, should initially place patients on contact precautions. Patients may be able to be moved to Enhanced Barrier Precautions.
• Dialysis clinics and providers should care for patients with C. auris using standard precautions. Health care personnel should wear disposable gowns and gloves during patient care or when touching items at the dialysis station. Gowns and gloves should be removed and disposed of carefully, and hand hygiene should be performed when leaving the patient’s station. Minimize exposure to other patients by placing the patient away from others or seeing the patient at the end of day.
• Outpatient Settings should care for patients with C. auris using standard precautions. Health care personnel should wear disposable gown and gloves if contact with infected areas is planned (e.g., debridement or dressing of colonized or infected wound). Gowns and gloves should be removed and disposed of appropriately, and hand hygiene should be performed when leaving the patient’s room.
• Home Health care settings should care for patients with C. auris using standard precautions. Health care personnel should wear disposable gown and gloves when entering the area of the home when providing patient care. Gowns and gloves should be removed and disposed of appropriately. Hand hygiene should be performed when leaving the patient care area. Minimize exposure to other patients by seeing the patient at the end of day.

Place all patients with confirmed or suspected C. auris infection or colonization in a private room. If a private room is not available:

• Patients infected or colonized with C. auris and/or other MDROs should be placed in rooms with patients colonized with the same organism(s). CDC does not recommend placing patients with C. auris in rooms with patients who have other types of MDROs.
• Avoid placing C. auris patients with patients who have indwelling devices (e.g., central venous catheter, tracheostomy tubes and mechanical ventilators), serious underlying medical conditions, or are otherwise immunocompromised.

Missouri DHSS does not currently recommend the discontinuation of precautions for a patient or resident with a current or history of C. auris colonization or infection.

 Interfacility Communication

Robust communication at the time of transfer ensures the continuation of infection prevention and control measures during transitions of care. This can be accomplished via verbal report at the time of transfer, in the discharge summary, or through the use of an interfacility transfer tool.

• Upon admission, ask about a patient’s C. auris and other MDRO status, if not included in the accompanying medical records.
• Upon admission, assess C. auris and other MDRO status for all patients by reviewing medical records and utilizing Electronic Health Records (EHR) or HL7 messages, especially for patients admitted from long term acute care hospitals or ventilator units.
• Upon discharge, communicate a patient’s C. auris and other MDRO status, including patients screened for an MDRO, but for whom laboratory results are not available at the time of transfer, to any receiving health care facility prior to transfer.

• This should be done by including a written notification of the infection or colonization to the receiving facility in transfer documents. The referring facility should ensure the documentation is readily accessible to all parties involved in patient transfer (e.g., referring facility, medical transport, emergency department, receiving facility). Missouri HAI/AR Program developed a fillable Interfacility Transfer Tool for facility use.

Containment Response

A single case of C. auris (active infection or colonization) requires a robust containment response. The DHSS HAI/AR Program may be conducting outreach to health care facilities and clinical laboratories with epidemiologic links to case patients or health care facilities with cases of C. auris infection. The risk of C. auris infection for otherwise healthy household members, even those with extensive contact, is believed to be low. However, household members who require admission to healthcare facilities can inform providers that they live with someone colonized with C. auris, so colonization testing can be considered. Additional information on containment can be found here: Infection Control Guidance from CDC including environmental disinfection.

Colonization Screening[1]

Missouri DHSS recommends screening patients for C. auris who meet any of the following criteria:

• Patients presenting from long-term acute care facilities, skilled nursing facilities, or rehabilitation facilities who, within the past 12 months, have history of
  • Multi-drug resistant organisms (MDROs)
  • Mechanical ventilation or tracheostomy
  • Chronic or unhealing wounds
• Patients hospitalized outside of the United States within the preceding 12 months
• Residents of states with historically high incidence of  C. auris, who also have extended stays in health care facilities (acute care and long-term care)

Testing of the environment or equipment for C. auris is not routinely recommended. Likewise, testing of health care workers or family members who care for patients with C. auris (or an exposure to C. auris) is not routinely recommended.

Clinical Laboratories

Clinical laboratories processing specimens from residents receiving health care in Missouri should implement methods to detect C. auris as outlined below:

• Use the CDC Candida auris laboratory resource and algorithm to identify C. auris based on the available phenotypic laboratory method and initial species identification.
• If your laboratory does not have methodologies required to speciate C. auris, talk with the HAI/AR Program to evaluate the utility of forwarding isolates suspicious for C. auris for further testing at commercial or public health laboratories that can perform C. auris identification. Please forward any positive C. auris isolates to the Missouri State Public Health Laboratory (MSPHL).
• If possible, perform speciation for all yeast isolates from an inpatient in a health care facility (acute care hospital, LTACH, or SNF), including from both normally sterile and nonsterile body sites. This activity may be particularly useful in the three months following the release of this alert, as we seek to understand the local epidemiology of C. auris in Missouri.
• CDC recommends that all yeast isolates obtained from a normally sterile site be identified to the species level so appropriate initial treatment can be administered based on the typical, species-specific susceptibility patterns.
• Species-level identification of Candida isolates from non-sterile sites should be conducted in the following circumstances:

• If clinically indicated in the care of the patient.
• To detect additional colonized patients when a case of C. auris infection or colonization has been detected in a facility or unit.
• If the patient has had an overnight stay in a health care facility within an identified domestic C. auris hotspot, or outside the U.S. in the previous year, especially in a country or region with documented C.auris transmission.
• If the patient currently or previously resided in skilled nursing facilities with ventilated patients or in long term acute care hospitals.

Reporting

Health care facilities, providers and laboratories with suspected or confirmed cases of C. auris (active infection or colonization), should report them to the DHSS HAI/AR Program at 573-751-6113 or the DHSS Emergency Response Center (ERC) at 800-392-0272. C. auris is implicitly reportable in Missouri as an emerging or unusual disease per the Regulatory Documentations of Reportable Diseases and Conditions in Missouri (19 CSR 20-20.020). C. auris became nationally notifiable in 2018.

Please contact the Missouri DHSS HAI/AR Program for:

• Patients newly colonized or infected with C. auris (immediately notifiable)
• Guidance on C. auris screening of roommates or other close contacts
• Guidance on patient cohorting (i.e., grouping patients infected with the same infectious agents together to confine their care to one area and prevent contact with susceptible patients)
• Guidance on infection control interventions
• Questions regarding HAI Surveillance (ex. reporting, specimen collection, and specimen submission to the MSPHL)

The Missouri DHSS HAI/AR Program can be contacted at the following email address: info@health.mo.gov

Full Background information on C. auris can be found in the original Emerging Candida auris Infection Cases in Missouri Health Care Facilities Health Alert from December 6, 2023, found at https://health.mo.gov/data/hai/

Previous versions of this Health Update can be found at https://health.mo.gov/emergencies/ert/alertsadvisories/

References

Worsening Spread of Candida auris in the United States, 2019 to 2021 | Annals of Internal Medicine (acpjournals.org)

CDC C. auris Homepage

Infection Control Guidance: Candida auris

EPA List P

Implementation of Personal Protective Equipment (PPE) Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs) | HAI | CDC

Identification of Candida auris | Candida auris | Fungal Diseases | CDC

Target Audience

Local Health Departments, Infectious Disease Physicians, Hospital Emergency Departments, Infection Control Preventionists, Health Care Providers, Long Term Care Facilities, Dialysis Clinics, and Laboratories

Author

MDHSS Healthcare Associated Infections/Antimicrobial Resistance Program, the State Epidemiologist, and Division of Community and Public Health.

For additional Information visit health.mo.gov.

Submitted by: ERC Duty Officer, Emergency Response Center (ERC) Missouri Department of Health & Senior Services 912 Wildwood Dr., PO Box 570 Jefferson City, MO 65102-0570 Phone: 573-526-9711, Facsimile: 573-526-8389 Email: DRMS@health.mo.gov

Having trouble viewing this email? https://content.govdelivery.com/accounts/MODHSS/bulletins/405cd55