4,012 Candidozyma auris cases reported across the EU and EEA, 2013–2023

The number, and the machinery that produced it

On 11 September 2025 the European Centre for Disease Prevention and Control published its fourth survey of Candidozyma auris, the yeast first described in 2009 from a patient in Japan as Candida auris and now placed in the genus Candidozyma; ECDC keeps both names in the report’s title. EU and EEA countries reported 4,012 cases of colonisation or infection across the eleven years from 2013 to 2023. The instrument behind that figure was a ten-question form sent on 7 June 2024 to the National Focal Points for Healthcare-associated Infections, asking for aggregated cases and outbreaks per year, an epidemiological stage, and an account of national laboratory capacity and preparedness. Thirty-six countries replied. The report carries doi 10.2900/2025052, and the species sits in the critical priority group of the WHO fungal priority pathogens list.

It is worth fixing what 4,012 is not. It is the EU/EEA subtotal, not a figure for Europe. The same table gives a survey total of 4,133 once the enlargement countries, invited for the first time, are counted. Six of the seven invited replied and reported 121 cases between them: Türkiye 114, Kosovo 6, Bosnia and Herzegovina 1. Montenegro and North Macedonia had detected none, Albania did not respond, and Serbia’s eight cases fall in 2024, outside the period the survey covers.

Eleven bars, read in order

Year by year the EU/EEA series runs 0, 1, 3, 159, 273, 236, 149, 342, 637, 804 and 1,346 from 2013 to 2023. Read in that order it is not a smooth climb. There is an early peak of 273 in 2017, which ECDC attributes mainly to an outbreak in Spain, a fall through 2018 and 2019, and only then the rise that ends at 1,346 cases from 18 countries in 2023. Those eleven bars add to 3,950; the remaining 62 are cases Italy reported without being able to assign them to a year.

Resist the ranking that the country totals invite — Spain 1,807, Greece 852, Italy 712, Romania 404, Germany 120 — because the report explains where each set of numbers came from, and the provenance differs sharply. Spain has no national surveillance system at all: its national mycology reference laboratory asked 74 hospitals in its network for figures, and nine of them reported cases. Italian notification is mandatory but sparsely used, so in December 2024 the health ministry wrote to the regions; ten of twenty-one replied, five of those reported cases, and their returns were printed in the table instead of the notification data. Bulgaria records zero for 2013 to 2023 and four cases in 2025. And 2014, the first year carrying a case, is the first case inside the survey window rather than Europe’s first: a footnote records a French case identified retrospectively in 2007 and left out of the table.

What a case count can and cannot measure

ECDC’s own summary is blunt. The recorded numbers, it writes, “only reflect the tip of the iceberg as systematic surveillance is not in place in many countries”. In June 2024, 17 of the 36 participating countries had a national surveillance system for the yeast, nine had mandatory notification and 15 had national infection prevention and control guidance, while 29 had a mycology reference or expert laboratory. National figures rest largely on isolates submitted voluntarily, or on ad hoc collection in a subset of hospitals, and case definitions vary between all cases, infections only and bloodstream infections only. This is a questionnaire about what each country managed to count, not a routine surveillance stream.

Nor is the jump from the 1,812 cases of the 2022 survey all fresh transmission. ECDC places the newly reported cases mainly in 2022 and 2023, but adds that they also include retrospective corrections and cases for which the reporting year was not known. That caveat sits in the report itself; the press release carries only its broader cousin, that without systematic surveillance and mandatory reporting the true scale of the problem is likely to be under-reported.

Two further distinctions matter. The count merges colonisation with infection, so many of the people behind it carried the yeast without ever being ill — and which of the two a country counts moves its columns. German notification, made mandatory in July 2023, covers only isolates from blood and other normally sterile sites, while many of the isolates reaching the national reference laboratory came from colonised patients. ECDC also notes, citing the wider literature rather than this survey, that most isolates are resistant to fluconazole, that treatment failure and relapse are commoner than with other Candida species, and that mortality in C. auris candidaemia has been reported between 29 and 62 per cent. Those are background figures from elsewhere, and none of them is guidance for a patient or a clinician.

Reading your own country’s row

The most useful thing to do with the published survey is to find a country in Table 1 and ask what produced its number. The row for Poland carries no information at national level for 2013 to 2018, one case in 2019 and zero for 2020 to 2023 — a statement about testing, referral and reporting at least as much as about the yeast itself. Across the whole table, the staging system records something the raw counts hide: in Greece, Italy and Spain, between five and seven years passed from a documented first national case to regional endemicity.

One boundary belongs in a catalogue about fungi. C. auris has nothing to do with foraging or with eating mushrooms. It is a healthcare-associated yeast that moves between patients and persists on surfaces and medical equipment, and the entire report concerns wards, laboratories and infection control procedures. Nothing in it touches the fungi anyone picks in a wood.