Candida auris colonization among critically ill neonatal intensive care unit patients in Dhaka, Bangladesh.

Candida auris is a multidrug-resistant yeast causing invasive infection and healthcare-associated outbreaks globally. We aimed to estimate the extent of C. auris colonization and infection among neonates in selected neonatal intensive care units (NICUs) in Dhaka City. We conducted a prospective study from August 2021 to September 2022. Skin swabs and blood samples were collected from NICU patients. C. auris was identified using CHROMagar and VITEK-2. Patient characteristics and healthcare histories were recorded. Of 374 patients enrolled, 32 (9%) were colonized with C. auris, and one (0.3%) developed a bloodstream infection (BSI). The median age of the enrolled patients was 4 days (IQR: 2-8); 60% were male. Among the colonized patients, 44% (14/32) were colonized at enrollment, and 56% (18/32) became colonized after enrollment, occurring 3-19 days after admission. Of patients colonized on admission, five (36%) were admitted from the obstetric ward, eight (57%) from another hospital, and one (7%) from home. Seven (22%) of the 32 colonized patients, including the one with BSI, died. All deaths occurred in public hospitals. Three (9%) C. auris isolates demonstrated resistance to two antifungal drug classes. Our findings suggest frequent transmission of C. auris within the NICU, as demonstrated by more than half of the patients acquiring colonization after 48 h of admission. The high rate of C. auris transmission underscores the critical need for improved patient detection and robust infection prevention and control measures. Further investigation into C. auris transmission dynamics is crucial to inform prevention strategies.IMPORTANCECandida auris is a serious fungal pathogen that is resistant to multiple antifungal medications. It is a significant concern in healthcare settings, particularly in neonatal intensive care units (NICUs) where vulnerable newborns are at increased risk of infection. This may be a serious public health issue due to its high mortality, limited treatment options, risk of transmission, and strain diversity.