Medical case reports of Candidozyma auris (syn. Candida auris) infections in Europe - a systematic review

Candidozyma auris (syn. Candida auris) is a hazardous multi-drug resistant yeast that causes severe infections in hospitalized patients. Many uncertainties exist around its antifungal resistance, clinical presentation, dominant clade, and isolation sites in the European setting. Therefore, to properly assess these characteristics, we systematically reviewed case reports in Europe between the first case described in 2009 and January 2023.

We conducted this systematic review according to the PRISMA guidelines. Cases of both symptomatic and asymptomatic patients have been included. We extracted patients' demographics, C. auris isolation site, identified clade, clinical presentation, clinical outcome, as well as treatment. The case reports have been assessed for quality using standardized tools.

Out of 251 identified articles, 12 reports from 10 European countries describing 15 cases are included In the review. The youngest affected person was an infant and the oldest was 74 years old.  Blood was the most common isolation site, reported in 26% of reported cases. The fatality rate could not have been reported due to the high number of asymptomatic patients and comorbidities or other infections in symptomatic patients. About 91% of reported isolates were resistant to fluconazole, 18% to amphotericin B and none was resistant to echinocandins. The quality assessment revealed that about 33% of case reports had a high risk of bias.

Our results show that any age group can be affected. The antimicrobials of choice in the European setting seem to be the echinocandins, although proper standardized susceptibility breakpoints are needed.