Candida auris in Europe: Epidemiology and antifungal resistance. A systematic review.
BACKGROUND Candida auris is a widely distributed yeast that is considered a dangerous pathogen, with reported mortality rates ranging from 30% to 60%. This yeast shows a high level of resistance to several antifungal agents commonly used to treat systemic infections. The pathogen persists on contaminated surfaces, tolerates hospital-grade disinfectants, survives desiccation and spreads easily through direct or indirect contact. It has been reported on all five continents and is increasingly prevalent in Europe. OBJECTIVE To determine the distribution and antifungal susceptibility/resistance of Candida auris isolates identified in Europe until January 2025. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were conducted in EBSCOhost, MEDLINE/PubMed, Scopus and SciELO databases using the terms 'Candida auris' and 'Candidozyma auris', combined with the name of each European country. It was limited to English or Spanish articles published until 31 January 2025, excluding reviews, meta-analyses and book chapters. RESULTS Ninety-one articles reporting antifungal susceptibility were retrieved, covering 2191 clinical isolates of C. auris from 16 countries. Most isolates were from Spain (n = 886, 40.44%), Italy (n = 553, 25.24%), Greece (n = 214, 9.77%), the United Kingdom (n = 182, 8.31%) and Russia (n = 108, 4.93%), accounting for 88.68% of cases. The remaining 248 isolates (11.32%) were reported across 11 other countries. Fluconazole resistance was found in 90.51% (1555/1718), while resistance to amphotericin B and echinocandins was 13.17% (223/1693) and 4.57% (76/1693), respectively. CONCLUSIONS Candida auris has been predominantly detected in Southern Europe, where the majority of clinical isolates exhibit resistance to fluconazole. Consensus is essential for timely diagnosis, targeted treatment and infection control to prevent its spread. New therapeutic options must be explored to manage Candida auris.