The skin as a reservoir for Candidozyma auris: colonization dynamics, host defense, and decolonization challenges

Abstract

Abstract Candidozyma auris has emerged as one of the most formidable fungal pathogens of the modern era, designated a critical priority pathogen by the World Health Organization due to its multidrug resistance, thermotolerance, and capacity to cause prolonged outbreaks in healthcare settings. Unlike most fungal pathogens, C. auris exhibits a remarkable tropism for human skin, where it persists asymptomatically, forms biofilm-like structures resistant to conventional antiseptics, and serves as a reservoir for nosocomial transmission. Invasive infections, particularly candidemia, carry mortality rates of 40-60% and disproportionately affect immunocompromised individuals and those with prolonged healthcare exposure. Six geographically distinct clades have been described, each differing in antifungal susceptibility, colonization capacity, and virulence. Despite the clinical urgency, the molecular and immunological mechanisms governing cutaneous colonization, persistence, and the transition to invasive infection remain poorly understood. This review examines the biology, virulence, and skin colonization dynamics of C. auris, with emphasis on experimental models (i.e. murine, porcine, and human skin systems) that have advanced our understanding of host-pathogen interactions, immune responses, and the efficacy of antifungal and decolonization strategies, highlighting critical knowledge gaps and future research priorities.