Predictors and Patterns of Metastatic Candidozyma auris Infection, Spain, 2016-2024

Metastatic infection after Candidozyma auris candidemia remains poorly characterized. We retrospectively studied patients with C. auris candidemia at a tertiary hospital in Spain during 2016-2024. Of 108 patients, 24 (22.2%) experienced metastatic infections; endocarditis was most frequent (7.4%), followed by osteoarticular infection, meningitis, and hepatosplenic infection (3.7% each). In multivariable Fine-Gray regression, a cardiac device or prosthetic valve was independently associated with metastatic infection (subdistribution hazard ratio [HR] 2.89 [95% CI 1.21-6.91]), although that association was attenuated in a sensitivity analysis restricted to echocardiographed patients. Persistent candidemia showed a higher, nonsignificant risk for metastatic infection in the day-5 landmark analysis (subdistribution HR 2.67 [95% CI 0.86-8.32]). Metastatic infection was associated with increased deaths in time-dependent analyses at 60 days (adjusted HR 2.21 [95% CI 1.04-4.67]) and 90 days (adjusted HR 2.26 [95% CI 1.09-4.67]). Our findings support echocardiography in patients with intracardiac devices.