Candidozyma auris (C auris) is an opportunistic, multidrug-resistant fungus associated with a high mortality rate and sustained transmission in both healthcare and environment settings, representing significant public health concerns. Genomic studies have identified distinct clades of C auris, each with specific antifungal resistance traits. This study evaluated the potential of wastewater surveillance for the detection and clade-level characterization of C auris. Between March 2023 and February 2024, a total of 23,212 wastewater samples were systematically collected from multiple sampling sites across Abu Dhabi and Al Ain. Isolates were confirmed by Matrix-Assisted Laser Desorption/Ionization–Time of Flight Mass Spectrometry and subsequently characterized through whole-genome sequencing (WGS) for taxonomic resolution. Antifungal susceptibility testing was performed by broth microdilution. Here we demonstrate direct culture-based isolation of ten C auris positives ( ~ 4 per 10,000 samples). Phylogenetic and mating-type analyses classify nine isolates as Clade I and one as Clade VI. WGS further reveals ERG11 gene mutation in the clade VI isolate, conferring azole resistance. Antifungal susceptibility testing by broth microdilution reveals elevated Minimum Inhibitory concentration (MIC) to at least one antifungal drug in all isolates studied, while two isolates exhibited elevated MICs to agents spanning more than two drug classes. To our best of knowledge, these findings represent the first regional detection of Clade VI C auris, highlighting wastewater surveillance as a valuable complementary tool for healthcare-based monitoring. Such approaches can provide insights into the transmission dynamics and antifungal resistance of emerging C auris clades that may otherwise remain undetected until its clinical detection. Candidozyma auris (C. auris) is a harmful fungus that can cause serious infections, especially in people with weak immune systems. It spreads easily in hospitals, is hard to detect, and is often resistant to medicines, which makes outbreaks difficult to control. In this study, we looked at whether wastewater could be used to monitor the presence of C. auris. We found that C. auris can be detected in wastewater samples, importantly, one isolate belonged to a rare type that, to the best our knowledge has not been seen in this region before. Many of the isolates were resistant to one or more antifungal drugs. These results show that wastewater monitoring could help public health authorities to detect C. auris early and take action to prevent infections before they spread. Kusuma, Almansoori, Shanmugam, et al. analyze wastewater samples from Abu Dhabi, UAE, to assess the presence of the pathogenic fungus Candidozyma auris. The study demonstrates that C. auris can be detected in wastewater, including a rare clade (VI) not previously reported in the region, highlighting wastewater surveillance as an effective early warning tool for outbreak prevention.
Kusuma et al. (2026) studied this question.