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Candida auris as an emerging threat in intensive care units: A single-center retrospective study
Bülent Kaya1, Serap Demir Tekol2, Elif Bombacı3
1Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kartal Dr Lütfi Kırdar City Hospital, Istanbul, Türkiye.
Objectives:
Candida auris is an emerging multidrug-resistant fungal pathogen associated with health care-associated outbreaks, particularly, in intensive care units, and is increasingly recognized as a cause of invasive bloodstream infections worldwide.
Methods:
This retrospective single-center study analyzed C. auris isolates obtained from blood cultures of 31 patients admitted to the mixed intensive care units of a tertiary multidisciplinary training and research hospital between December 2021 and December 2024. Demographic characteristics, underlying comorbidities, antifungal susceptibility profiles, treatment strategies, and in-hospital outcomes were systematically evaluated using hospital information system records.
Results:
The median age was 61 years (range, 21-87), and 55% were male. Fluconazole resistance was detected in 60% (18 of 30) of isolates. Automated susceptibility testing indicated elevated amphotericin B minimum inhibitory concentration values in all isolates; however, the reliability of automated methods for amphotericin B testing in C. auris remains controversial. All isolates remained susceptible to caspofungin and micafungin, and voriconazole susceptibility was inferred based on fluconazole minimum inhibitory concentration values. Echinocandins were used as first-line therapy. In eight (25.8%) patients, C. auris was identified in blood cultures after patient death.
Conclusions:
After the identification of C. auris, this institution implemented enhanced infection control measures, including contact isolation, environmental decontamination, and reinforcement of antifungal stewardship. Despite these interventions, delayed detection and limited access to reference susceptibility testing remained major challenges. These findings highlight the need for strengthened active surveillance, rapid diagnostic capacity, and standardized susceptibility testing to reduce nosocomial transmission and improve clinical outcomes in high-risk intensive care settings.
Insights
Candida auris bloodstream infections are a growing threat in intensive care units. This study found high fluconazole resistance and echinocandin susceptibility, emphasizing the need for better surveillance and diagnostics.
Area of Science:
- Infectious Diseases
- Mycology
- Critical Care Medicine
Background:
- Candida auris is an emerging multidrug-resistant fungal pathogen causing healthcare-associated outbreaks globally.
- It is increasingly recognized as a significant cause of invasive bloodstream infections, particularly in intensive care settings.
Purpose of the Study:
- To analyze the characteristics, antifungal susceptibility, and outcomes of Candida auris bloodstream infections in a tertiary care hospital.
- To evaluate the effectiveness of implemented infection control measures and identify challenges in managing C. auris.
Main Methods:
- Retrospective single-center study of 31 patients with C. auris blood cultures from December 2021 to December 2024.
- Evaluation of demographic data, comorbidities, antifungal susceptibility profiles, treatment strategies, and in-hospital outcomes.
- Utilized hospital information system records for data extraction.
Main Results:
- A high prevalence of fluconazole resistance (60%) was observed in C. auris isolates.
- All isolates remained susceptible to echinocandins (caspofungin, micafungin), which were used as first-line therapy.
- Delayed detection and limited access to reference susceptibility testing posed significant challenges.
Conclusions:
- Strengthened active surveillance, rapid diagnostics, and standardized susceptibility testing are crucial for controlling nosocomial transmission of C. auris.
- Enhanced infection control measures, including isolation and environmental decontamination, are necessary.
- Improving diagnostic capacity is vital for better clinical outcomes in high-risk intensive care settings.
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