Risk Factors for Mortality Among Patients with Bloodstream Infection Caused by Candidozyma auris in Colombia

Background: Candidozyma auris (Candida auris) is an emerging multidrug-resistant fungal pathogen that can cause hospital outbreaks and is associated with high mortality. However, data on the clinical predictors of mortality in patients with bloodstream infection (BSI) caused by C. auris remain limited, particularly in Latin America, and the impact of guideline-based management practices on clinical outcomes has been scarcely explored. Methods: We conducted a multicenter retrospective cohort study including 134 patients with culture-proven C. auris BSI admitted to seven hospitals in Colombia between 2016 and 2021. Demographic, clinical, and therapeutic variables were evaluated to identify factors associated with 30-day mortality using a multivariate logistic regression model. Variables related to quality of care and guideline-based candidemia management, included in the EQUAL Candida Score, were also assessed. Results: The thirty-day mortality rate was 38.1%. In the multivariate analysis, older age (OR per decade: 1.37; 95% CI: 1.07-1.78), prior corticosteroid therapy (OR: 4.06; 95% CI: 1.70-10.16), and shock within 48 h of BSI (OR: 6.22; 95% CI: 2.52-16.52) were associated with higher mortality. Conversely, a higher EQUAL Candida Score was associated with lower 30-day mortality (OR: 0.84; 95% CI: 0.73-0.97). Conclusions: In this large Colombian cohort, advanced age, corticosteroid exposure, and early hemodynamic instability were significant predictors of mortality in patients with C. auris BSI. Greater adherence to recommended management practices-as reflected by the EQUAL Candida Score-appeared to be associated with lower mortality, underscoring the potential role of timely, structured care strategies in improving outcomes for patients with C. auris infections. To the best of our knowledge, this study is the first to evaluate the EQUAL Candida Score in a cohort of patients with C. auris BSI.