Environmental continuum of Candidozyma auris: from sapronotic ecology to outbreak prediction and control with a One Health perspective.

Candidozyma auris (formerly Candida auris) has emerged within just over a decade as one of the most relevant multidrug-resistant fungal pathogens affecting human health worldwide. Its pathogenicity, capacity for skin colonization, environmental persistence, and resistance to antifungal drugs and disinfectants have all contributed to its consolidation as a leading cause of healthcare-associated outbreaks. Nevertheless, increasing evidence indicates that C. auris should not be viewed solely as a nosocomial yeast, but rather as part of a broader environmental continuum encompassing natural habitats, anthropogenic niches, and multiple host species. Environmental isolates have been documented in coastal wetlands, wastewater systems, agricultural products, as well as in diverse animals - including companion animals, reptiles, amphibians, and insects -supporting its classification as a sapronotic pathogen. The near-simultaneous emergence of distinct clades across continents strongly suggests that climate change, agricultural azole exposure, and ecological adaptation have collectively selected strains exhibiting thermotolerance, antifungal resistance, and cross-kingdom persistence, thereby enabling recurrent spillover into human populations. Recent advances in wastewater-based epidemiology demonstrate that C. auris can be detected at the community level, often preceding clinical recognition, while animal colonization underscores its overlooked role in pathogen maintenance and transmission networks. This review synthesizes current evidence on the ecological, evolutionary, and epidemiological determinants of C. auris, positioning outbreaks as amplification phenomena within interconnected ecological systems rather than isolated nosocomial events. Adoption of a One Health framework, integrating environmental, veterinary, and human health surveillance, will be essential for predictive outbreak modeling, early detection, and the development of sustainable strategies to mitigate the ongoing and future threats posed by this emerging fungal pathogen.