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Predictors of Candida auris Infection in Previously Colonized Patients: A Retrospective Cohort Study from a Large
Nadide Ergün1, Sevim Selen Karabulut1,2, Melda Türken1,2
1Department of Infectious Diseases and Clinical Microbiology, Izmir City Hospital, Izmir 35540, Türkiye.
Abstract:
Candida auris is a multidrug-resistant fungal pathogen associated with high mortality in healthcare settings. Although colonization is recognized as the harbinger of invasive infection, predicting which patients will develop bloodstream infection (BSI) and when this transition will occur remains a clinical challenge. In this study, patients aged ≥18 years with C. auris colonization identified at İzmir City Hospital between January 2023 and June 2025 were retrospectively analyzed. Colonization was confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Of 71 colonized patients (median age 65 years; 69.0% male; 93.0% intensive care unit (ICU)-admitted), 31 (43.7%) developed bloodstream infection (BSI). In-hospital mortality was 62.0%, rising to 74.2% in the BSI group, though this difference did not reach statistical significance (p = 0.105). Competing risks analysis using the Aalen-Johansen method showed a cumulative BSI incidence of 38.2% (95% confidence interval (CI): 28-50%) by day 10 and 43.0% (95% CI: 32-54%) by day 30 following colonization detection. On multivariate logistic regression, diabetes mellitus was the sole variable independently associated with a lower risk of BSI development (adjusted odds ratio (OR): 0.19; 95% CI: 0.06-0.68; p = 0.010); this finding was directionally consistent but did not reach statistical significance in the multivariable Fine-Gray competing risks model (subdistribution hazard ratio (SHR): 0.334; 95% CI: 0.108-1.040; p = 0.057). All 40 tested isolates had high fluconazole minimum inhibitory concentration (MIC) values; micafungin susceptibility was 92.5%, while anidulafungin resistance was observed in 32.5% of isolates. Our findings demonstrate that nearly half of colonized patients developed BSI, with no identifiable safe window for intervention, underscoring the necessity of sustained infection control measures and susceptibility-guided antifungal therapy.
Insights
Nearly half of patients colonized with Candida auris developed bloodstream infections (BSI) within 30 days. This highlights the urgent need for infection control and targeted antifungal therapy in healthcare settings.
Area of Science:
- Infectious Diseases
- Mycology
- Critical Care Medicine
Background:
- Candida auris is a multidrug-resistant fungus causing high mortality in healthcare settings.
- Predicting invasive bloodstream infection (BSI) from colonization is a significant clinical challenge.
- Early identification and intervention are crucial for managing C. auris infections.
Purpose of the Study:
- To determine the incidence and timing of bloodstream infection (BSI) development in patients with Candida auris colonization.
- To identify risk factors associated with the transition from colonization to invasive BSI.
- To assess antifungal susceptibility patterns of C. auris isolates.
Main Methods:
- Retrospective analysis of patients aged ≥18 years with C. auris colonization at İzmir City Hospital (January 2023 - June 2025).
- Colonization confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS).
- Competing risks analysis (Aalen-Johansen) and multivariate logistic regression were used to assess BSI development and risk factors. Antifungal susceptibility testing was performed.
Main Results:
- Of 71 colonized patients, 43.7% developed BSI. Cumulative BSI incidence reached 43.0% by day 30 post-colonization detection.
- Diabetes mellitus was associated with a lower risk of BSI development (adjusted OR: 0.19; p=0.010).
- High fluconazole resistance was observed; micafungin susceptibility was 92.5%, but anidulafungin resistance was 32.5%.
Conclusions:
- Nearly half of C. auris colonized patients progressed to BSI, with no safe window for intervention.
- Sustained infection control measures are essential.
- Antifungal therapy should be guided by susceptibility testing, considering resistance patterns.
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