Comparison of risk factors and mortality of candidemia by Candida auris versus Candida non-auris in intensive care units.

OBJECTIVES

This study aims to compare risk factors and mortality of candidemia by Candida auris versus Candida non-auris in intensive care units (ICU).

METHODS

A total of 437 ICU patients who developed candidemia (90 C. auris, 143 C. albicans, 204 other Candida spp.) in 2021-2023 were included. The risk factors in candidemia caused by C. auris, C. albicans and other Candida spp. were compared. Factors associated with 30-day mortality in C. auris candidemia were explored.

RESULTS

Compared to the C. albicans group, the C. auris group had more frequent ceftazidime avibactam use (OR:6.72, 95%CI: 1.29-34.98, p = 0.024) and tracheostomy (OR:4.13, 95%CI: 1.70-10.02, p = 0.002), longer colistin (OR:1.07, 95%CI: 1.01-1.13, p = 0.021) and urinary catheter use (OR:1.02, 95%CI: 1.01-1.03, p = 0.023). Compared to the other Candida spp. group, colistin use (OR:2.79, 95%CI: 1.61-4.87, p < 0.001), chronic obstructive pulmonary disease (OR:2.02, 95%CI: 1.05-3.90, p = 0.036) and concurrent bacteraemia (OR:1.92, 95%CI: 1.06-3.48, p = 0.030) were more frequent in the C. auris group. Rate of 30-day mortality was lower in C. auris patients (63.3%) compared to the C. albicans (82.5%) and other Candida spp. (75.5%) groups. While the 30-day mortality rate was higher in C. auris patients who received vasopressor therapy (OR:3.12, 95%CI: 1.78-5.47, p < 0.001) and had high lactate levels (OR:1.41, 95%CI: 1.00-1.99, p = 0.047) and low platelet counts (OR:1.00, 95%CI: 0.99-1.00, p = 0.003) on the first day of candidemia, it was lower in patients with microbiologic response (OR:0.03, 95%CI: 0.01-0.09, p < 0.001).

CONCLUSION

The necessity of broad-spectrum antibiotics and indwelling catheters should be routinely reassessed to reduce C. auris candidemia. Lower mortality was linked to microbiologic response; thus, fungal eradication should be prioritised in clinical practice.