Incarceration status is not a part of routine C. auris reporting, but health departments often notify CDC of cases with unusual epidemiology, such as cases in correctional facilities. We included in this report all C. auris cases in incarcerated patients that had previously been reported to CDC. We also conducted proactive outreach to state health departments and the Federal Bureau of Prisons to identify any additional cases that had not previously been reported to CDC.

We investigated all reported clinical and screening cases of C. auris among patients who were transferred or resided in to a jail, state prison, or federal prison in the United States after having a positive C. auris specimen during January 2020–December 2022. We used established CDC case definitions for clinical and screening cases (8). We collected epidemiologic information for each case and calculated basic descriptive statistics for C. auris case type, type of healthcare facility where the positive specimen was collected, patient age, patient health conditions at the time of transfer to a correctional facility, type of correctional facility where the patient was transferred, and type of housing arrangements. Through emails and phone calls, we provided open-ended questions to health departments, departments of corrections, and the Federal Bureau of Prisons about challenges with patient management and infection control and prevention for C. auris that they encountered or that were reported by correctional facilities.

This report describes cases of C. auris reported among patients in US correctional facilities. Cases occurred among patients in geographic areas with high C. auris prevalence and with recent hospital admissions, consistent with prior reports that C. auris is predominantly transmitted and acquired in healthcare environments (2,3). Although underlying conditions were common, not all patients had typical risk factors for C. auris at the time of transfer back to the correctional facility. However, data about risk factors were not collected systematically and did not necessarily reflect possible risk factors present at the time of C. auris acquisition. Although all but one patients in this report had their first positive C. auris specimens identified at offsite hospitals, transmission in onsite medical units was not fully assessed because comprehensive screening of healthcare contacts was not conducted for all cases. In the future, comprehensive screening in response to cases in correctional medical units could help determine whether transmission is occurring in these settings.

This report highlights unique challenges to C. auris patient management and IPC in correctional medical settings. Although no setting-specific guidance for C. auris response in correctional facilities exists, strategies outlined in MDRO containment guidance for healthcare settings would apply (10,11). Those guidelines focus on ensuring adherence to recommended IPC practices, conducting screening of healthcare contacts or new admissions on the basis of the local epidemiology, and communication about patients’ C. auris status during transfers to other facilities. Specific guidance for different facility types (e.g., nursing homes, long-term acute care hospitals, and dialysis clinics) should be adapted for correctional facility medical units on the basis of the type of unit and acuity of care provided (10–12). Strong communication and collaboration between public health agencies and correctional facilities can increase awareness about resources needed to implement IPC policies and facilitate timely response to MDROs. Facilities could work with local health departments to proactively assess their IPC practices and plan C. auris response activities after a case is identified (13). Health departments can also share local epidemiologic information to guide practices in correctional medical units, such as screening.

Risk for C. auris transmission in nonhealthcare settings is not completely understood, but persons in nonhealthcare settings generally lack typical risk factors for C. auris (3). No evidence exists to suggest that incarcerated patients colonized with C. auris should not be discharged to the facility’s general population. Disposition and decisions to discharge patients from medical units should be based on clinical criteria and healthcare need, not on C. auris status alone (10). Management for patients in general population units could draw from methicillin-resistant Staphylococcus aureus, tuberculosis, and other corrections-specific infectious disease guidance, which focus on routine health education and providing soap or ABHS to patients and close contacts, such as roommates (5,6,14–16). ABHS was provided in many facilities during the COVID-19 pandemic, and such policies could be adapted to ensure access to ABHS (17). Screening of contacts, such as those with frequent inpatient healthcare exposures, could be considered in specific situations, such as those outlined in MDRO containment guidance for residential care settings (11). Housing patients in general population units with low-risk roommates, such as those without underlying medical conditions or indwelling medical devices, could further reduce infection risk. Communication of MDRO status should always occur when a patient is transferred to offsite healthcare facilities or to different correctional facilities. To reduce the risk for stigma, knowledge of a patient’s MDRO status should be restricted to staff who need this information to ensure that the patient is housed and receives medical care according to recommended IPC principles.

One limitation of this report is that all cases in incarcerated patients may not have been included because C. auris case detection and reporting may be incomplete and incarceration status is not a part of routine case reporting. Data on patient medical conditions also were collected in a nonsystematic manner and only for those present at the time of transfer, not at the time C. auris was acquired; some patients may have had risk factors for C. auris that were not reported (3). Information about onsite medical units (e.g., bed counts, acuity of care, and infection control compliance) also was not systematically collected but could improve characterization of potential facility-level risk factors for C. auris transmission. Furthermore, assessing where transmission occurred was not possible because persons can be colonized for a prolonged period, C. auris screening information was not available for offsite hospitals, and comprehensive screening was not conducted in all onsite medical units.

Although uncommon, C. auris colonization or infection may occur in persons who are incarcerated, particularly persons with known C. auris risk factors and recent healthcare encounters in geographic areas with high C. auris prevalence. Measures to manage cases and prevent C. auris spread in correctional facilities should account for the unique challenges of implementing recommended IPC and response measures and caring for patients with C. auris in healthcare and nonhealthcare environments within correctional settings.