Middletown health presenter outlines rise, risks and control steps for Candida auris

Doctor Genowind, presenting to the Middletown Board of Health on April 8, 2025, described Candida auris as an emerging fungal pathogen that is increasingly being identified in U.S. patients and poses particular risks for severely ill, hospitalized and long‑term care patients.

Genowind said the organism is notable for drug resistance and diagnostic challenges and summarized public‑health guidance for screening and infection control. "So Candida auris... is essentially a new species of fungus," Genowind said, and "the biggest issue with Candida is it is drug resistant," describing resistance to common azole drugs and growing resistance to amphotericin B and, in a smaller fraction of cases, echinocandins.

The presentation placed the pathogen's U.S. emergence in context: Genowind said Candida auris was first identified in 2009 internationally and first reported in the United States in 2016. Using Centers for Disease Control and Prevention (CDC) data presented to the board, Genowind said U.S. case counts rose sharply through 2023, with the presenter citing roughly 5,020 U.S. cases reported in 2023 and a cumulative total on the order of 10,000 cases across several years; she said the organism has been identified in most states and is concentrated in large urban centers with major ICUs and long‑term care facilities.

Genowind described who is at greatest risk and why the fungus spreads in health‑care settings: patients with prolonged hospital stays, intensive‑care and ventilator patients, people with central lines or other indwelling devices, recent surgery, advanced age and substantial prior antibiotic exposure. She stressed that colonization can occur on skin and in warm, moist body sites and that transmission is primarily by contact, which makes admission screening, contact precautions, single‑use or dedicated equipment and the correct disinfectants critical in hospitals and nursing homes.

On diagnosis and treatment, Genowind said cultures historically led to misidentification but that rapid PCR testing is now available to shorten detection from days to hours; once Candida auris is identified, she emphasized doing antifungal susceptibility testing to guide therapy. She told the board that mortality for invasive infections remains serious — she quoted a 15–35 percent mortality range for severely ill adults and 10–15 percent for affected neonates — and that some isolates are now resistant to all three major antifungal classes, prompting combination therapy and the recent introduction of a new FDA‑approved antifungal class.

Board members asked procedural and practical questions during a brief Q&A about admission screening sites (armpit/groin/nares swabs or PCR testing), the role of single‑use equipment and when patients or families should request special precautions; Genowind said routine patients generally remain low risk and that infection‑control programs screen and focus precautions on higher‑risk admissions.

The briefing did not include any formal board action; it was presented for education and to inform ongoing public‑health planning and infection‑control coordination with Butler County and regional hospitals.