The rise of Candidozyma auris in Czechia: three clades, prosthetic joint infection and fluconazole resistance development, 2022 to 2024.

BACKGROUNDCandidozyma auris has emerged globally as a major threat to public health due to its outbreak causing capacity and antifungal resistance. Outbreaks have proven difficult to control despite enhanced infection prevention measures. Thus, national surveillance is warranted.AIMWe aim to characterise the epidemiology of C. auris cases in Czechia between 2022 and 2024 to investigate whether autochthonous spread is occurring and asses antifungal resistance.METHODSHigh-resolution genotyping was performed to assess genetic relatedness between isolates. Microbroth dilution was performed on all isolates and underlying mechanisms resistance were inspected with whole genome sequencing.RESULTSEight cases from seven different hospitals were reported, mainly collected from non-sterile sites, in addition to the first documented prosthetic joint infection by C. auris. Only two patients reported travel history. Three clades were found, with the first report of Clade IV in Europe. For one patient, initial isolates were pan-susceptible but after short exposure to fluconazole became resistant with a novel mechanism.CONCLUSIONC. auris reported in Czechia in patients without travel history suggests autochthonous spread. Three clades were present, often with unknown route of introduction. Development of fluconazole resistance upon brief exposure highlights the ability of C. auris to rapidly evolve.