Alice Brewer, MPH, CIC, CPHQ, FAPIC, PDI Senior Director of Clinical Affairs

Alice Brewer, MPH, CIC, CPHQ, FAPIC

, multiple drug-resistant fungus, 3D illustration

(Adobe Stock 823501227 by peterschreiber.media)

—has become one of the most concerning pathogens facing health care systems today. First identified in the US in 2016, this multidrug-resistant fungus has moved from an emerging threat to a persistent reality in hospitals and health care facilities. The 

 an urgent antimicrobial resistance (AR) threat, due to its high mortality risk, treatment challenges, and ability to spread rapidly in health care settings.

 reflects an update in fungal taxonomy, not a change in the organism itself or its clinical significance. Here’s the reasoning in clear, practical terms:

1. Advances in genomic sequencing
Modern whole-genome sequencing showed that 

 is genetically distinct from many other species historically grouped under 

. While it behaves clinically like other 

 species, its evolutionary lineage is different.

2. The “Candida” genus was too broad
For decades, 

 functioned as a catch-all genus based largely on morphology and clinical behavior rather than true genetic relatedness. Molecular phylogenetics has revealed that 

 species are spread across multiple evolutionary branches.

3. Reclassification improves scientific accuracy
The genus 

Its distinct biology, including environmental persistence and antifungal resistance

Its separation from more common commensal 

4. Alignment with international naming standards
Mycological classification bodies periodically update nomenclature to align names with evolutionary data. This renaming follows the “1 fungus, 1 name” principle used in modern fungal taxonomy.

Clinical risk: Still a CDC-designated urgent antimicrobial resistance threat

Transmission dynamics: Still spreads via surfaces, equipment, and hands

Regulatory language: Many agencies and labs still use 

What This Means for Health Care and IPC Teams

 may appear in scientific literature and lab reports

 remains the dominant term in clinical practice, CDC guidance, and regulatory documents

Infection prevention strategies, reporting requirements, and control measures remain exactly the same

This is a scientific naming correction, not a downgrade, upgrade, or redefinition of the threat. The organism’s behavior in health care settings hasn’t changed, only our understanding of where it fits on the fungal family tree.

 clinical cases have been reported across dozens of US states, representing a more than 

 since 2022, according to the CDC Clinicians and infection prevention professionals have been managing growing case levels for nearly a decade. This pattern reflects long-term persistence rather than a temporary spike, signaling an ongoing challenge for health care facilities. What has changed is geography: Once concentrated in major port-of-entry states such as California, New York, Florida, and Texas, 

 is particularly dangerous because it is resistant to multiple first-line antifungal therapies. It is frequently misidentified as a more common 

species, leading to delayed or ineffective treatment. In vulnerable patients, especially those who are immunocompromised or have invasive devices such as central lines or catheters, this delay can allow infection to progress rapidly and lead to sepsis and organ failure.

species that are endogenous to the human body, 

 is typically acquired from the environment. It can persist on both human skin and in the health care environment for extended periods, making it uniquely suited to spread. Transmission often occurs through contaminated surfaces, shared medical equipment, and the hands of health care workers.

Detection also remains a challenge. Although laboratory identification has improved significantly over the past decade, 

 can still be misidentified without specialized testing. This underscores the importance of close collaboration between clinical teams, microbiology laboratories, and local or state health departments to ensure specimens are sent quickly to facilities capable of accurate identification.

Delayed detection increases the risk of silent transmission. Patients who are colonized but not properly identified can unknowingly spread the organism, leading to clusters or outbreaks, particularly in high-acuity units such as intensive care units or long-term acute care hospitals.

Environmental contamination plays a significant role in 

 transmission, more so than with many other pathogens. It can persist on surfaces and withstand routine cleaning practices if disinfection is incomplete or improperly executed.

Effective environmental hygiene requires the use of disinfectants that are proven effective against 

. Standardized application, including complete surface coverage and compliance with labeled use directions, supports reliable disinfection outcomes. Approaches that reduce complexity and variability can help reinforce consistent practices, particularly in high-risk care settings.

While manual cleaning remains essential, the tools and delivery methods used can influence results. 

 of dilutable disinfectants and automated dispensing systems have identified variability in final-use concentrations, emphasizing the need for routine monitoring to confirm proper function.

 Reusable cleaning textiles, including microfiber cloths and cotton towels, have also demonstrated disinfectant binding and residual microbial contamination even after laundering, which may increase the risk of pathogen transfer.

Presaturated, single-use disinfectant wipes offer a more user-friendly and standardized option by delivering a consistent disinfectant dose directly to surfaces without the need for onsite dilution, dispenser calibration, or textile reprocessing. Their ready-to-use design supports efficient workflows, helps reduce cross-contamination, and promotes more consistent cleaning practices. High-touch surfaces, shared equipment, and patient surroundings should remain priority areas, particularly during outbreaks or when caring for high-risk populations.

The core infection prevention strategies for 

 are familiar, but their consistent execution is critical.

 remains the first and most important line of defense. Hand hygiene products, including wipes and sanitizers containing 70% or more alcohol, are effective against 

 and are widely recommended for routine use. They are often more accessible than soap and water, making them a practical option in clinical settings. Hand wipes offer the added benefit of mechanical friction, which helps physically remove dirt and organic soils that can interfere with antimicrobial activity.

 is essential. Facilities should ensure disinfectants listed on EPA List P are readily available and used according to label instructions, including required contact times, to effectively eliminate environmental contamination.

), including gowns and gloves, should be used consistently when interacting with affected patients or their environment. Importantly, health care workers must perform hand hygiene both before using gloves and after removing them—a step that is frequently overlooked.

Proper cleaning and disinfection of medical equipment

 also deserves special attention. Devices such as ventilators, monitors, instruments, and other shared equipment can serve as reservoirs if not thoroughly disinfected between uses.

can help reduce cross-contamination by delivering controlled disinfectant dosing and minimizing the risk of spreading organisms from one surface to another compared to reusable cloths or liquid applications.

 are other key strategies. Whenever possible, patients with suspected or confirmed 

 should be placed in single rooms to limit spread.

plays a central role. Clinicians, nurses, and environmental services teams must understand how 

 presents, how it spreads, and why strict adherence to protocols matters.

 case is identified, immediate action is essential. Patients should be placed under appropriate isolation precautions according to facility policy, and the local health department should be notified promptly to guide testing, reporting, and contact tracing.

Specimens must be collected and quickly sent to qualified laboratories for confirmation. While treatment is often started with broad-spectrum antifungals before results are available, rapid identification remains critical to guide clinical management and containment efforts.

Preparedness should occur well before a case is detected. Facilities should ensure they have adequate supplies of appropriate EPA List P disinfectants, PPE, and alcohol-based hand hygiene solutions. Infection prevention teams should also maintain up-to-date contact information for public health partners and regularly review response protocols.

 is unlikely to disappear. Most experts no longer consider it an emerging pathogen; it is now endemic in many health care settings worldwide. While new treatment options may eventually emerge, prevention strategies are unlikely to change dramatically. The fundamentals, including hand hygiene, environmental cleaning, isolation, and education, remain the cornerstone of control.

 reflects its distinct genetic and biological characteristics, including its environmental persistence and antifungal resistance. While the name may evolve, the threat remains the same. 

Health care teams should expect continued cases, with potential seasonal fluctuations tied to higher hospitalization rates during cold and flu seasons. Sustained vigilance, consistent infection prevention practices, and strong collaboration across clinical, environmental, and public health teams will be essential to limit the impact of this formidable pathogen.

Cadnum JL, Kaple CE, Eckstein EC, Saade EA, Ray AJ, Zabarsky TF, Guerrero BJ, Yassin MH, Donskey CJ. Dilution dysfunction: evaluation of automated disinfectant dispenser systems in 10 hospitals demonstrates a need for improved monitoring to ensure that correct disinfectant concentrations are delivered. 

Watson R. What the quat?! Decreased disinfectant concentration due to quat binding observed between a quat-based disinfectant and microfiber cloths. 

Boyce JM, Sullivan L, Booker A, Baker J. Quaternary Ammonium Disinfectant Issues Encountered in an Environmental Services Department. 

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Alice Brewer, MPH, CIC, CPHQ, FAPIC

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