<i>Candida auris</i> colonization among critically ill neonatal intensive care unit patients in Dhaka, Bangladesh

<i>Candida auris</i> is a multidrug-resistant yeast causing invasive infection and healthcare-associated outbreaks globally. We aimed to estimate the extent of <i>C. auris</i> colonization and infection among neonates in selected neonatal intensive care units (NICUs) in Dhaka City. We conducted a prospective study from August 2021 to September 2022. Skin swabs and blood samples were collected from NICU patients. <i>C. auris</i> was identified using CHROMagar and VITEK-2. Patient characteristics and healthcare histories were recorded. Of 374 patients enrolled, 32 (9%) were colonized with <i>C. auris</i>, and one (0.3%) developed a bloodstream infection (BSI). The median age of the enrolled patients was 4 days (IQR: 2-8); 60% were male. Among the colonized patients, 44% (14/32) were colonized at enrollment, and 56% (18/32) became colonized after enrollment, occurring 3-19 days after admission. Of patients colonized on admission, five (36%) were admitted from the obstetric ward, eight (57%) from another hospital, and one (7%) from home. Seven (22%) of the 32 colonized patients, including the one with BSI, died. All deaths occurred in public hospitals. Three (9%) <i>C. auris</i> isolates demonstrated resistance to two antifungal drug classes. Our findings suggest frequent transmission of <i>C. auris</i> within the NICU, as demonstrated by more than half of the patients acquiring colonization after 48 h of admission. The high rate of <i>C. auris</i> transmission underscores the critical need for improved patient detection and robust infection prevention and control measures. Further investigation into <i>C. auris</i> transmission dynamics is crucial to inform prevention strategies.IMPORTANCE<i>Candida auris</i> is a serious fungal pathogen that is resistant to multiple antifungal medications. It is a significant concern in healthcare settings, particularly in neonatal intensive care units (NICUs) where vulnerable newborns are at increased risk of infection. This may be a serious public health issue due to its high mortality, limited treatment options, risk of transmission, and strain diversity.