Candida Auris Outbreak in the Burn Unit: Risk Factors and Characteristics

Abstract Introduction Candida auris (Corynebacterium auris) is an emerging multidrug-resistant fungal pathogen increasingly recognized as a cause of nosocomial outbreaks. Burn patients are at particular risk of acquiring this pathogen because of impaired skin integrity, frequent invasive procedures, immune dysfunction, and treatment with broad-spectrum antimicrobials. Herein, we describe our experience with C. auris in a 17-bed burn unit, to better understand their colonization and infection risks. Methods This is a program improvement project. Our epidemiology team collected information on burn patients who tested positive for C. auris from 10/29/2024 to 6/30/2025. Demographics, comorbidities, hyperglycemia on admission, burn injury information and management, and C. auris detection information were collected. Descriptive statistics were obtained. Results Eight burn patients were positive for C. auris, five (62.5%) via polymerase chain reaction as a part of point prevalence studies and three (37.5%) by culture. Six (75%) were defined as C. auris colonization and two (25%) as C. auris infections based on receipt of targeted therapy. All patients were placed on broad spectrum antibiotics. The median time from admission to positivity was 17 days IQR: 10-30.8. All patients were white and male with a median age of 55 years IQR: 32-74. Only two presented with a history of diabetes mellitus, one had a history of neoplastic disease. None had a history of chronic kidney disease, immunocompromised state, or recent surgery. The median total burn surface area (TBSA) was 17% IQR: 5.6-48.8. Six (75%) presented full thickness burns and three (37.5%) had inhalation injury. All patients were hyperglycemic on admission (glucose median level:174 IQR: 144-199). Four (50%) had a central venous line, seven (87.5%) had an indwelling urinary catheter. Four (50%) required mechanical ventilation and stayed on a ventilator for an average of 15 days. The median hospital length of stay was 47 days IQR: 13-51. Conclusions Over a 9-month period, eight burn patients were positive for C. auris colonization and infection. A positive C. auris culture led to screening procedures to identify transmission on the unit to other patients. Some traditional risk factors were not met for acquisition of C. auris, such as time in other facilities. Multiple traditional risk factors were present, including use of medical devices, prolonged inpatient stays, frequent surgical procedures, and widespread use of antimicrobials. Applicability of Research to Practice Burn units should consider a C. auris surveillance program for patients in a burn unit should C. auris be identified in a clinical specimen. Specifically, facilities may consider routine surveillance for patients with prolonged stays and/or risk factors. Further study is warranted to identify the clinical significance of C. auris positivity in burn-injured populations. Funding for the study N/A.