Yeast identification, antifungal susceptibility testing, and Candida auris screening practices at acute care hospitals and long-term acute care hospitals, United States

Accurate species identification and antifungal susceptibility testing (AFST) are critical for detection and clinical management of emerging antifungal-resistant yeasts such as Candida auris. C. auris colonization screening is essential for preventing its spread. However, nationally representative data on these practices are limited. We analyzed data from 5,333 acute care hospitals (ACHs) and 359 long-term acute care hospitals (LTACHs) enrolled in Centers for Disease Control and Prevention (CDC)'s National Healthcare Safety Network (NHSN), Patient Safety Component (PSC), specifically facility responses to the 2024 NHSN survey. Nearly all hospitals (≥99%) reported having yeast identification performed, most frequently at on-site laboratories (ACH: 41%, LTACH: 32%) or affiliated medical center laboratories (ACH: 28%, LTACH: 30%). Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was the predominant method used (ACH: 71%, LTACH: 63%); use of chromogenic agar to differentiate Candida isolates was less common (ACH: 27%, LTACH: 32%). Most hospitals (≥96% of ACHs and LTACHs) reported having AFST performed, primarily at a commercial laboratory (ACH: 55%, LTACH: 49%) rather than on-site or at an affiliated facility. Routine C. auris screening was less common (ACHs: 21%, LTACHs: 33%). Among those, 86% of LTACHs and 3% of ACHs reported universal admission screening. These data provide updated benchmarks of yeast identification, AFST, and C. auris screening in U.S. hospitals. Reliance on off-site AFST might delay results, potentially impairing timely treatment decisions and step-down therapy. National benchmark data on C. auris screening could help guide efforts to improve containment strategies. Importance: Accurate yeast identification and antifungal susceptibility testing (AFST) are important for detecting and managing drug-resistant fungi, particularly Candida auris. Screening patients for C. auris also helps prevent spread, but national data on these practices are limited. We analyzed data from 5,333 acute care hospitals (ACHs) and 359 long-term acute care hospitals (LTACHs) reporting to Centers for Disease Control and Prevention (CDC)'s National Healthcare Safety Network, Patient Safety Component (PSC). Nearly all hospitals reported having yeast identification and AFST available, although these services were often performed at off-site or commercial laboratories, which may delay results and affect timely treatment decisions. Most hospitals used matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) for yeast identification, while fewer routinely used chromogenic agar to differentiate Candida isolates, representing a potential opportunity to strengthen laboratory practices. Routine C. auris screening was reported by 21% of ACHs and 33% of LTACHs. These findings provide national benchmarks that may help guide efforts to improve detection and containment of C. auris.