Natural clearance time and effect of manuka honey body wash and oral probiotics on colonization of Candidozyma auris (Candida auris) among residents of older adults homes in Hong Kong.
Ma E, Lai R, et al. • Frontiers in public health • 2026
The median natural clearance time for C. auris colonization in older adult residential care home residents was 427 days for controls and 224 days for the intervention group, but cases and controls showed no statistically significant difference in C. auris clearance duration.
Key Findings
Results
The median time for 50% of residential care home residents to clear C. auris colonization was 224 days in the intervention group and 427 days in the control group.
215 cases (intervention group) and 190 controls were analyzed
Clearance was estimated using Kaplan-Meier methods
Clearance of C. auris was defined as culture negative for at least three consecutive specimens collected monthly
Despite the numerical difference in median clearance times, the two groups showed no statistically significant difference in C. auris clearance duration
Results
Decolonization using manuka honey body wash and oral probiotics did not produce a statistically significant reduction in C. auris colonization time compared to controls.
The intervention consisted of manuka honey baths and oral probiotics containing Lactobacillus rhamnosus GG and Saccharomyces boulardii
215 intervention cases and 190 controls were analyzed with no major differences in demographic characteristics
Kaplan-Meier analysis was used to compare clearance times between groups
The cases and controls 'showed no statistical difference in C. auris clearance duration'
Discussion
C. auris colonization persists for a prolonged duration in older adult residential care home residents, posing significant infection control challenges.
The study reviewed C. auris cases in residential care homes for the elderly (RCHE) in Hong Kong from 1 June 2019 to 31 December 2024
The median natural clearance time in the control group was 427 days
The authors note that 'the long natural clearance time for C. auris poses pressure on infection control practices in RCHE'
C. auris is described as a 'multidrug-resistant healthcare-associated fungal pathogen' most commonly associated with bloodstream infections with 'high global mortality rates'
Methods
The study population consisted of 215 intervention cases and 190 control cases from residential care homes for the elderly in Hong Kong with no major demographic differences between groups.
Data were collected from RCHE residents in Hong Kong
Follow-up ran from 1 June 2019 until residents cleared the fungus or died, up to 31 December 2024
No major differences in demographic characteristics were found between the intervention and control groups
Outcomes tracked included clearance of C. auris or death during the follow-up period
Conclusions
The authors recommend further randomized controlled trials and investigation of other treatment modalities to reduce C. auris transmission in care home settings.
The current study was not a randomized controlled trial, which is a noted limitation
The authors explicitly state: 'Further research in randomized controlled trials and other treatment modalities is encouraged to reduce its transmission'
The lack of effective decolonization strategies highlights an unmet need in managing C. auris in long-term care settings
What This Means
This research suggests that Candida auris (C. auris), a drug-resistant fungal pathogen, takes an extremely long time to clear naturally from older adults living in residential care homes. In a study of over 400 residents in Hong Kong followed for up to five and a half years, the typical resident in the control group still carried C. auris after more than 14 months (427 days). This prolonged colonization creates ongoing challenges for preventing the spread of this potentially dangerous organism within care facilities.
The study also tested whether a combination of manuka honey body washes and oral probiotics (containing Lactobacillus rhamnosus GG and Saccharomyces boulardii) could help residents clear C. auris more quickly. While residents who received the intervention cleared the fungus somewhat faster on average (224 days versus 427 days), this difference was not statistically significant, meaning the results could have occurred by chance. Therefore, the study could not confirm that the intervention genuinely reduced colonization time.
This research matters because C. auris is associated with serious bloodstream infections and high mortality rates, and residential care homes for older adults are particularly vulnerable settings. The findings highlight that there is currently no proven decolonization strategy for C. auris in this population, and that its long persistence places sustained pressure on infection control teams. The authors call for larger, more rigorous randomized controlled trials to properly test decolonization approaches and identify effective ways to reduce transmission in care home environments.
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Ma E, Lai R, Chuang V, Shing B, Lui L, Hsu E, et al.. (2026). Natural clearance time and effect of manuka honey body wash and oral probiotics on colonization of Candidozyma auris (Candida auris) among residents of older adults homes in Hong Kong.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1899016